Ultrasonographic assessment of cross-sectional area of internal jugular vein and relationship of internal jugular vein and carotid artery

The internal jugular vein is a common site for central venous access. In the absence of ultrasound imaging, this procedure is traditionally performed using external landmarks and the carotid artery pulsation as a guide. The technique has been associated with a 6–9% rate of carotid artery puncture. Carotid artery puncture may be due, in part, to anatomic variation of the internal jugular vein specifically its size, location and relationship to the carotid artery. Ultrasound studies suggest that clinical maneuvers such as the Valsalva, an abdominal binder, or the Trendelenburg position alone or in combination, increase the cross-sectional area of the internal jugular vein, whereas extreme head rotation, carotid palpation, and needle advancement can distort or collapse the vein.