Introduction

Central venous access is frequently necessary for the management of critical illness presenting in the neonatal period. Especial attention should be given to the anatomical landmarks and technique for safe and successful central venous cannulation and catheter placement. Here, basic indications and anatomy are reviewed. Then, a simple technique for internal jugular vein (IJV) cannulation and catheter placement is described that is useful in children of all ages but particularly in neonates. Sufficient experience is mandatory. Clinical judgment should be used to ensure the indication and safety of this procedure.

Indications

• Lack of peripheral intravenous access (PIV)

• Administration of multiple medications

• Need for inotropes/vasopressors not feasible for PIV access

• Tranfusions

• Blood sampling

• Central venous pressure (CVP) monitoring

Anatomy

The internal jugular vein (IJV; vena jugularis interna) drains blood from the brain, face, and neck. It originates from the jugular foramen at the base of the skull and travels down the side of the neck in a vertical direction towards the midline. Initially, the IJV runs lateral to the internal carotid artery, and then lateral to the common carotid, in contact with the posterior border of the sternocleidomastoid muscle (SCM), see Figures 2.30 and 2.31. At the root of the neck the IJV joins the subclavian vein to form the innominate vein (= brachiocephalic vein = vena anonyma) and enters the thoracic inlet to become the superior vena cava (SVC).

Materials

• Ultrasound system, e.g., TITAN TM®

• Pediatric Two-Lumen Central Venous Catheterization Kit®. Included: two-lumen indwelling polyurethane catheter (4 F × 5 cm × 22 G lumen), Tegaderm™ dressing

• 24 G ¾″ JELCO®

• […]