Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter IX: Shock and Resuscitation

Internal Jugular Venipuncture

United States Department of Defense

Internal Jugular Venipuncture

1. Place the patient in a supine position, at least 15° with the head down to distend the neck veins and to prevent an air embolism. Turn the patient's head away from the venipuncture site.

2. Cleanse and prep the skin around the venipuncture site and drape the area. Sterile gloves should be worn when performing this procedure.

3. Introduce a large-caliber needle, attached to a 6 ml syringe, into the center of the triangle formed by the two lower heads of the sternomastoid and the clavicle.

4. After the skin has been punctured, turn the bevel of the needle upward and expel the skin plug that may occlude the needle.

5. Direct the needle caudally, parallel to the sagittal plane, at a 30° posterior angle with the frontal plane.

6. Slowly advance the needle while gently withdrawing the plunger of the syringe.

7. When a free flow of blood appears in the syringe, remove the syringe and occlude the needle with a finger to prevent an air embolism. If the vein is not entered on the first attempt, the needle generally is too medial. Withdraw the needle and direct it 5-10° more laterally.

8. Quickly insert the catheter to a predetermined depth (such that the catheter is above rather than within the right atrium).

9. Remove the needle and connect the catheter to the IV tubing.

10. Suture the catheter in place, apply antibiotic ointment, dress the area, and tape the tubing in place. Label the adhesive with the date of the procedure.

11. Obtain a chest film to check the position of the IV line and to rule out pneumothorax.

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Operational Medicine 2001

Health Care in Military Settings

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