Optimal head rotation for internal jugular vein cannulation when relying on external landmarks

Jeremy A. Lieberman, Kayode A. Williams, Andrew L. Rosenberg

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


External anatomic landmarks have traditionally been used to approximate the location of the neck blood vessels to optimize central venous cannulation of the internal jugular vein (IJV) while avoiding the common carotid artery (CCA). Head rotation affects vessel orientation, but most landmark techniques do not specify its optimal degree. We simulated catheter insertion via both an anterior and central approach to the right IJV using an ultrasound probe held in the manner of a syringe and needle in 49 volunteers. Increased head rotation from 0°, 15°, 30°, 45°, and 60° to the left of midline was associated with higher probability of a simulated needle contacting the IJV and the CCA. For both approaches, the risk of CCA contact was <10% for head rotations of ≤45°. Increased body surface area (BSA) and body mass index (BMI) were associated with more CCA contact at head rotations of 45° or 60°. To optimize IJV contact while reducing the likelihood of inadvertent contact with the CCA, the head should be rotated no more than 30° in patients with high BMI or BSA, but it may be turned to 60° if BMI or BSA is low.

Original languageEnglish (US)
Pages (from-to)982-988
Number of pages7
JournalAnesthesia and analgesia
Issue number4
StatePublished - Oct 2004
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Optimal head rotation for internal jugular vein cannulation when relying on external landmarks'. Together they form a unique fingerprint.

Cite this