Overview of Internal Jugular Vein Central Venous Access
Getting access to a central vein, which is a large vein close to the heart, is essential for certain medical procedures. It’s needed for giving a lot of fluids quickly, to keep an eye on how much fluid is in your body, and for patients who are difficult to insert a needle into their smaller veins (like those people who have swollen arm and leg veins or young children).
Sometimes a machine using soundwaves, called an ultrasound, might not be readily available to help guide the needle into the vein. In these cases, if access to the right jugular vein (which is in your neck) is needed, there’s a simple trick involving three fingers that doctors can use to insert a thin tube, known as a ‘central venous access line’, into this vein. The way this works is pretty simple and doesn’t depend on the patient’s size or whether they can turn their head to the left.
The doctor uses their left three fingers to create markers or guides on the patient’s neck, which then help to successfully insert the tube into the vein. The likelihood of complications using this three-finger technique is no higher than other commonly used methods, and may even be as safe as using an ultrasound.
Anatomy and Physiology of Internal Jugular Vein Central Venous Access
When considering the body’s structure, it’s important to move the windpipe gently to the side. Always keep your fingers touching the windpipe during this process. The aim is to make a muscle in your neck, called the sternocleidomastoid, tighten as much as possible. This is achieved by pushing it backwards with your fingertips, rather than to the side.
If a small needle (the ‘finder’ needle) is inserted into the skin and it doesn’t draw blood, it can be adjusted to point slightly more to the middle – but it’s important not to go beyond the mid-point of the muscle. Once the finder needle enters a large vein in your neck (called the ‘internal jugular’), another, larger needle (the ‘introducer’ needle) is placed directly over the finder needle and inserted at the same angle as the finder needle.
Why do People Need Internal Jugular Vein Central Venous Access
Central line catheters are special, flexible tubes that healthcare professionals insert into a large vein in a patient’s neck, chest, or groin to administer medication or draw blood. The reasons for inserting a central line catheter can be divided into two categories: emergency and non-emergency situations.
In emergency situations, a central line catheter can be critical for the patient’s survival or wellbeing. These emergencies might include:
- Placing a pacemaker to control abnormal heart rhythms
- Measuring the pressure in certain areas of the heart, such as the right atrium or even in the small blood vessels in the lungs
- Mesuring how well the heart is pumping blood throughout the body
- Administering large amounts of fluids quickly, especially in situations such as severe dehydration or shock
- Giving specific kinds of heart medications
- Performing a cardiac catheterization, a procedure to diagnose and treat heart conditions
- Performing emergency or temporary hemodialysis, which is a treatment that filters waste products and extra fluid from the blood when the kidneys are no longer capable of doing so
- Administering large volume of fluids when traditional methods, like a regular IV in the arm, aren’t working or possible
In non-emergency situations, these catheters are used for:
- Administering total parenteral nutrition, a method of feeding a person intravenously, bypassing the usual process of eating and digestion
- Patients who need to have their blood drawn regularly, such as individuals admitted to the intensive care unit for severe cases of high blood sugar (diabetic ketoacidosis) or bleeding in the digestive tract (gastrointestinal bleeding)
- Patients needing to receive certain solutions via their veins, such as hypertonic saline (a strong salt solution), large amounts of potassium, or calcium chloride
When a Person Should Avoid Internal Jugular Vein Central Venous Access
There are several reasons why a doctor might decide not to use a central line for venous access. This is a procedure where a tube is placed into a large vein in your neck, chest, or groin to give medications or fluids, or to collect blood samples. They may choose not to do this procedure if:
You have a severe coagulopathy or thrombocytopenia. These are medical terms for conditions where your blood doesn’t clot properly or you don’t have enough platelets (the cells that help your blood clot). Both of these could make the procedure risky.
If a patient is not able to cooperate or is behaving aggressively, which could make the procedure unsafe or impossible to carry out properly.
If the area where the tube would be inserted is unclean, burned, or otherwise injured, the procedure may not be safe to carry out.
Additionally, a central line should not be placed by a doctor or other healthcare professional who doesn’t have experience with the procedure. This is because the procedure is complex and requires specific skills to perform safely and correctly.
Equipment used for Internal Jugular Vein Central Venous Access
Most hospitals have a standard kit ready for a procedure called central venous catheterization. This procedure involves placing a flexible tube into a large vein in your neck, chest, or groin to give medications, fluids, nutrients, or blood products over a long period of time. Here is a general list of what can be found in the kit:
* A clear plastic cover with a hole in it
* An antiseptic called chlorhexidine with applicators to clean the skin
* A small needle to numb the skin (25 gauge by 1 inch)
* A big needle also to numb the skin or to locate the vein (usually 22 gauge by 1.5 inches)
* A special needle to introduce other instruments into the vein (usually 18 gauge by 2.5 inches)
* Small syringes (5 mL)
* A J-tip guidewire which is a long, thin wire that helps guide other tools into the correct place inside your vein
* A scalpel with a No. 11 blade for making a small cut in the skin
* A skin dilator to make the vein bigger
* A tube with three lumens (channels) or a sheath introducer to guide the catheter
* Sterile pads to soak up blood or fluids
* A stitch with a curved needle to seal the wound
* A tool to hold the needle
The doctor or nurse performing the procedure will also require:
* Sterile gloves, a sterile gown, a cap, and a mask with a protective shield to avoid any infections
* Sterile saltwater suitable for injection
* Sterile dressings to protect the wound
* Local anesthesia or 1% lidocaine to numb the area where the catheter will be inserted.
Who is needed to perform Internal Jugular Vein Central Venous Access?
Original: “The infant born at 24-28 weeks gestation has ongoing developmental changes of systems postnatally. The development of the immune system is occurring but is especially susceptible to environmental stimuli. Also, the lungs and kidneys are still developing. These continued developments of organ systems mean that they have additional vulnerability to the effects of medication, infection, and injury.”
Rewritten: A baby born between 24 to 28 weeks of their mom’s pregnancy is still growing and developing. Their immune system, which helps fight illnesses, is forming but is quite sensitive to what’s going on around them. Also, their lungs and kidneys, which help them to breathe and get rid of wastes, are not fully developed yet. This means that their organs are more open to the effects of medications, infections, and bodily harm.
Preparing for Internal Jugular Vein Central Venous Access
Before any medical procedure, it is essential to understand the risks and benefits. Some of the potential risks include infection, pain, local bleeding or a buildup of blood referred to as a hematoma, or a condition called pneumothorax/hemothorax, where air or blood collects in the space around the lungs. During the procedure, it would be ideal to monitor the patient’s heart rate to catch any irregular heartbeats, also known as dysrhythmias, which can be triggered during the procedure.
The patient’s neck and collarbone area are cleaned thoroughly using a disinfectant called chlorhexidine. This is done to get rid of any germs and lower the risk of infection. Local anesthesia is given to numb the area and ease any discomfort. If the patient feels anxious or doesn’t cooperate well, some medication might be given to help them feel relaxed during the procedure.
How is Internal Jugular Vein Central Venous Access performed
These steps are detailing how a doctor would get to your central veins (which carry blood back to your heart) via the right jugular vein in your neck. This might be done to place a catheter (a small, thin tube) into the vein for medical treatment.
1. You will lie down on your back, and your head will be turned a bit to the left side. This position means the procedure can be done successfully, no matter the angle that your head turns.
2. The doctor will use the fingers of their left hand to find the location of your windpipe (trachea). This is important to help guide where they will make the needle insertion.
3. The doctor then moves these fingers downwards until they find the muscle at the side of the neck (known as the sternocleidomastoid). The trachea, the muscle, and the joint where your collarbone meets your sternum (exactly in the middle of the chest bone) are all used as landmarks to help find the correct area to insert the needle.
4. In the middle of this found area, a needle is inserted to puncture the skin and get to the vein. Importantly, it is done at the level of the first joint of the doctor’s fingers and at an angle of 45 degrees to the skin surface, pointing towards the same side nipple. When the vein is punctured, blood is drawn into the attached syringe to confirm that they’re in the right spot.
5. Following this, a larger needle is introduced in this same spot. This is done to prepare for the placement of the catheter.
6. Afterwards, using a technique called the Seldinger technique, they’ll push a thin, flexible tube into the vein. This tube will help deliver medicine or nutrients, or draw blood.
7. When this process is completed, they will confirm that the tube is in the right place by checking a chest X-ray or testing a sample of your blood.
Possible Complications of Internal Jugular Vein Central Venous Access
When it comes to inserting a catheter into the jugular vein in your neck, there are some common risks that doctors take into careful consideration. These risks include accidentally puncturing a large artery in the neck or the chest, causing a collapsed lung, forming a blood clot, leaking blood outside the blood vessels, and blood accumulating in the chest’s space. There are also rare but severe complications, including formation of a false blood vessel bulge, puncturing the main artery leading from the heart, pressure buildup in the heart due to fluid accumulation, injury to an artery in the neck, and in extreme cases, even death. If the guide wire used in the procedure touches the inner lining of the heart, this can disrupt the heart’s rhythm. However, injury to the thoracic duct, a major body part involved in moving lymph fluid, doesn’t tend to happen when doctors access the right side of your internal jugular vein.
What Else Should I Know About Internal Jugular Vein Central Venous Access?
This method is used to insert a catheter (a small, flexible tube) into a large vein in your neck (the right jugular vein). It’s useful because it doesn’t rely on being able to see certain body features that can be different in people with larger or shorter necks.
Although using an ultrasound to guide the placement of the catheter is common, it’s not always possible. Some reasons for this could be not having ultrasound machines available, especially in less-developed areas, or the person doing the procedure might not be comfortable using ultrasound. Other times, people may avoid using ultrasound because they think it will make the procedure take longer.
This method of placing a catheter into the right jugular vein is particularly good in situations where you don’t have ultrasound access.
