Dr. Ayoub et al. have published a thorough and excellent review of the use of ultrasound for cannulation of the internal jugular vein.1 Both the incidence of complications and the failure rate were found to be reduced significantly with the use of ultrasound.x We have experienced similar results in our department. In fact, our medical board considers the role of ultrasound for internal jugular vein cannulation to be of such importance that they adopted a policy to use ultrasound for the placement of all internal jugular vein catheters. We also have an additional departmental policy stipulating that the position of the initial catheter must be checked by manometry prior to converting it to an indwelling central catheter. Manometry can be accomplished by attaching sterile tubing to the catheter, filling the tubing with blood, and then elevating the tip of the tubing such that the blood drains back into the vessel, which it will do if accessing the jugular vein.
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