External Jugular Vein

To access the external jugular vein, standard human central venous catheter kits can be used; the Seldinger technique is most reliable.

The external jugular vein is in the jugular furrow (Figure 5) and is punctured distal to the junction of the proximal tributaries. Clip the hair and perform a sterile preparation (including draping). Create a small skin nick using a #11 scalpel blade or an 18-gauge needle over the intended catheter insertion site to facilitate skin penetration (Figure 6).

A large bore over-the-needle catheter is inserted through the skin and directed caudally into the external jugular vein (Figure 7). The opposite hand can be used to occlude the vein. Following full insertion of the over-the-needle catheter (Figure 8), a Seldinger guide wire is inserted into the hub of the catheter (Figure 9).

The guide wire is advanced about two-thirds of the way, and then the catheter is removed, leaving the guidewire in place (Figure 10). It is essential to maintain control of the guidewire. A single or multi-lumen central venous catheter is advanced over the guidewire (Figure 11). Use of a dilator is often necessary before this step to enlarge the puncture in the skin and vessel to accommodate the catheter diameter.

The catheter is advanced into the external jugular vein (Figure 12). The guidewire should extend from the proximal end of the catheter. Remember to always maintain control of the guidewire. Once the catheter is fully inserted, the guidewire is removed, and an injection port is attached to the catheter hub (Figure 13).

Secure the catheter to the MWD’s skin with suture through the wings of the catheter hub, and circumferentially around the catheter base (Figure 14). The central venous catheter should then be secured on the MWD’s neck with roll gauze or cast padding (Figure 15) followed by non-adherent bandage material (Figure 16). At least two fingers should be able to be placed under the bandage to ensure it is not too tight. Always monitor the MWD for any signs of facial swelling or respiratory distress caused by the bandage being too tight.