Arterial vessels behind the right internal jugular vein with relevance to central venous catheterisation

During right internal jugular vein cannulation, complications can arise due to transfixion of the posterior wall and damage to other vessels. The risks to the subclavian artery and its branches are less well appreciated than the carotid artery. Example images are lacking in the literature. Using ultrasound and cadaveric studies, we aim to provide clinically relevant images of at-risk vessels posterior to the right internal jugular vein to emphasise their close proximity, and provide strategies to avoid potential complications. Using ultrasound in 24 patients, we found the presence of numerous arterial vessels (excluding the carotid) within 8.0 mm of the posterior wall of the right internal jugular vein at the levels of the mastoid, cricoid and supraclavicular region. Cadaveric dissections further highlighted the close proximity of numerous branches of the subclavian artery. Vulnerable branches of the subclavian artery include the thyrocervical trunk, inferior thyroid and vertebral arteries. More inferior approaches to right internal jugular vein cannulation are likely to put more arterial branches at risk. Higher resolution ultrasound enables visualisation of these arteries prior to cannulation. If identified, measures should be taken to avoid vein transfixion and arterial damage.