To the Editor:
We read with great interest the updated report by the American Society of Anesthesiologists Task Force on Central Venous Access about the practice guidelines for central venous access 2020.1
The relation between internal jugular vein and carotid artery at various head positions may deserve special attention. In a prospective observational study of 1,136 patients, 54% of the patients had internal jugular vein overlying the carotid artery (internal jugular vein overlying more than 75% of the carotid artery in an ultrasound image plane aligned in the direction of cannulating needle).2 The vessel overlap would increase the incidence of accidental carotid puncture, which is the most common complication during cannulation of internal jugular vein (associated with 6.3% to 9.4% of procedures).3
Several studies have demonstrated the progressive increase in overlap between internal jugular vein and carotid artery with the incremental head rotation to opposite side.4–7 While performing internal jugular vein cannulation, in addition to the Trendelenburg position and use of ultrasound, minimizing head rotation to the contralateral side may help to decrease the incidence of carotid artery puncture and enhance safety.8
Competing Interests
The author declares no competing interests.
