ANATOMICAL LANDMARKS

Central venous catheter access utilizes the following vein choices:
 · Internal Jugular/External Jugular
 · Subclavian
 · Axillary
 · Femoral

The best approach or access point varies depending on clinical need, patient condition, current coagulation state, tools available and inserter skill set.

INTERNAL AND EXTERNAL JUGULAR VEINS



The internal and external jugular veins lie on either side of the neck and bring blood from the head, face and neck toward the heart. Both ultimately unite with the subclavian vein.

The internal jugular begins at the base of the skull and runs down the neck, lateral to the carotid artery. Toward the bottom of the neck, it is overlaid by the sternocleidomastoid muscle (SCM) which stretches obliquely across the side of the neck and forms fleshy fibers at the clavicle. It is large, easy to locate and has easy access to the superior vena cava (SVC) (15).