The Medial-Transverse Approach for Internal Jugular Vein Cannulation: An Example of Lateral Thinking

BACKGROUND: Cannulation of the internal jugular vein (IJV) is traditionally performed using the central-longitudinal approach. Pneumothorax, carotid artery puncture, and failure to cannulate are uncommon, but by no means rare, complications. Ultrasound (US) guidance for IJV cannulation has reduced but not eliminated such complications. TECHNIQUE: We herein introduce a new approach, coined the "medial-transverse approach" due to the perpendicular angle at which the introducer needle is advanced toward the IJV from the median to lateral direction. DISCUSSION: The direction of the introducer needle is not toward the lung, thus virtually eliminating the possibility of pneumothorax. The image of the entire needle is seen when the US probe is typically orientated for a short-axis view of the IJV and carotid artery, thus improving the chance of uncomplicated IJV puncture. We have used this technique with apparent success in thousands of cases over the past 20 years in two different institutions. CONCLUSION: A modified IJV cannulation technique that seems to have unique advantages over traditional approaches has been described. This technique is compatible with the blind and US-guided approaches.