- [Narrator] This video is for demonstration
and educational purposes only.
Please follow your own institutional guidelines
on sterility and safety.
A linear array transducer with a venous exam type
is used to perform an ultrasound guided insertion
of an internal jugular catheter via a transverse approach.
The patient is in a supine position
with the head slightly turned
towards the contralateral side.
The operator is positioned at the head of the bed.
The transducer is placed transversely just below the apex
of the sternocleidomastoid muscle triangle,
with the orientation marker directed to the operator's left
at a nine o'clock position.
The most superficial structure identified
in the ultrasound image is the sternocleidomastoid muscle.
Deeper to this, the internal jugular vein
will appear as an anechoic elliptical shape
that is compressible with transducer pressure.
In contrast, the anechoic circular artery will be pulsatile.
The thyroid gland lies medial to these structures
and has a light gray echo signature.
In the ultrasound image, the internal jugular vein
will appear superficial to the carotid artery.
Adjust the transducer so the internal jugular vein
is centered within the ultrasound image.
With the needle positioned just superior to the transducer,
slowly insert the needle next to the center line
on the transducer.
The needle will appear as a small bright dot
in the ultrasound image.
When the needle tip appears,
slide the transducer a short distance away,
until the tip is no longer visible.
Once again, advance the needle slowly
until it is visible in the ultrasound image.
Repeat the process to ensure that the needle tip is advanced
under direct ultrasound guidance.
Continue advancing the needle
until the tip is seen to indent
and then puncture the internal jugular vein.
Confirm that the needle tip
lies in the mid portion of the jugular vein
by rotating the probe 90 degrees
to get an in plane longitudinal view of the needle
within the jugular vein.
