About this episode
Contributor: Travis Barlock, MD
Educational Pearls:
What is an internal jugular catheter (IJ) and when do we use it?
- IJs are catheters that can be placed in either the left or the right internal jugular vein to provide central venous catheter (CVC) access. CVCs can be placed in other locations other than the internal jugular vein (i.e. subclavian vein or femoral veins).
- IJs are used when the patient may require long-term venous access or have to receive hyperosmolar solutions (such as solutions with high glucose content for parenteral nutrition); solutions with extreme pHs (<5 or >9); or vesicant drugs (drugs that can cause tissue necrosis with extravasation).
- They are not to be confused with EJs (external jugular vein catheters) which can be placed in difficult to peripherally catheterize patients. EJs function similarly to a peripheral IV.
- The advantage of IJs is their location in larger veins brings them closer to direct access to the heart (i.e. the right internal jugular vein will provide immediate/quicker access to the right atrium to the heart.)
What are concerns of using a right internal jugular catheter versus one in the left?
- The right internal jugular vein provides quick access to the heart via the right atrium, making it ideal in critically ill patients who may require vasopressor support.
- However it is also the site commonly used for additional cannulation procedures such as hemodialysis, pulmonary artery pressure measurements, extracorporeal membrane oxygenation (ECMO) and transvenous pacemaker placement.
- These procedures are not uncommon in critically ill patients who also required a CVC for initial hemodynamic support via vasopressors.
- Gharaibeh et al. found that patients who received a right IJ and hemodialysis had a higher need for re-insertion of the hemodialysis catheter (40% compared to 2.6% in the left IJ group).
- Furthermore, it was found that with a right IJ, hemodialysis catheters had to be exchanged by a guidewire in 23% of those with a right IJ as opposed to 0.9% in the left IJ group (a guidewire exchange is often considered a salvage technique to try and maintain access).
Big Takeaway?
- If you are able to obtain an IJ on the right, you can likely obtain one on the left, and if considering longitudinal care for your patient, consider obtaining an IJ on the left to allow for future critical access in the right IJ.
References
- Gharaibeh KA, Abdelhafez MO, Guedze KEB, Siddiqi H, Hamadah AM, Verceles AC. Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications. Journal of Critical Care. 2025;87:155011. doi:10.1016/j.jcrc.2024.155011
- Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA: A Cancer Journal for Clinicians. 2008;58(6):323-346. doi:10.3322/CA.2008.0015
Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Jorge Chalit, OMS4
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Emergency Medical Minute — Podcast 999: Right vs Left Internal Jugular Access. Machine-transcribed; use the interactive transcript above to jump the player to any line.
This is the emergency medical minute sponsored by CarePoint and HCA Health One. So we often have to put in central lines, right, for patients who are sick, who need pressers usually, right? And there's lots of locations that we can put them in. We put them in their neck, as in the IJ, we can put them in a subclavian, also the femoral vein as another source, another side that we can place a central line. And where do you most commonly see us place central lines? In the neck, right? Huh? You adjust it to the neck, right? Okay. That is a very common place to put it. And then do you more commonly see a place on the right or the left? Right. The right. So the right IJ is very common sight for placing a central line, because it's just like a straight shot straight to the right atrium, just a straight shot down. So it makes sense that we do that.
Now the thing is that if you do that, that kind of is occupying a site where patients can only get dialysis or get ECMO or CRRT or things like that. So it is true that this is like a great site, but it's a great site for that reason. And you're kind of also taking the site away for the patient, for other things that may need done the road. There was a study that was done that it was in the Journal of Critical Care, and it was titled Right IJ CBC associated with hemodialysis catheter complications. And so initiating Right IJ catheters as opposed to the left results in less favorable outcomes for hemodialysis later on. The right IJs required more frequent hemodialysis catheter recannulation, so 40% compared to 2.6% and a higher incidence of hemodialysis catheter exchange over a guide wire with the right IJs versus the left.
There's also a significantly greater number of venous interventions that are required. So basically we should probably be doing, if you can do a right IJ, we should be doing a left. You can also probably do a left IJ. So that's all, this question of all medical minute on central lights. This has been the emergency medical minute. Thank you to our sponsor's CarePoint and HCA Health One. Support from them and listeners like you helps us to continue providing free medical education to the masses. If you found this episode valuable, consider supporting our work and check out the link in our show notes.
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