Real-time ultrasound guided internal jugular vein catheterization in the emergency department

Establishing central intravenous access in the emergency department (ED) is often both crucial and difficult. In patients with nonexistant or ambiguous external anatomic landmarks, a real-time ultrasound guided approach to internal jugular vein cannulation is useful. In addition, the use of ultrasound guidance in internal jugular vein cannulation is supported by reports that have documented reductions in number of cannulation attempts, time required to establish central access, and rate of complications. The use of ultrasound for establishing central venous access has never been described in an ED setting. Two such cases in which ultrasound was extremely helpful for establishing central access in an ED are reported, the techniques employed for real-time ultrasound guidance of internal jugular vein catheterization are described, and the literature that supports the use of this technique is reviewed.