Ultrasound guidance and visualization of anatomy and/or the needle tip during jugular venous cannulation is, essentially, the standard of care given the frequency of complications using anatomic landmarks alone – not to mention the “growing” U.S. population that has outgrown their landmarks. It’s also the standard of care because residents finishing their training right now have never done an IJ without the ultrasound.
So, what do we do when we don’t have ultrasound? Then you’re left with the decision to do subclavian or femoral.
Well, ultrasound-guided subclavians are well-described in the literature, and this is an article from our critical care colleagues with 400 subclavian access attempts – half with landmarks and half with ultrasound. Fewer complications, fewer attempts, less time to access. Hard to argue with that. If you aren’t getting familiar with ultrasound, I would start thinking about ways to become more comfortable.