Anatomic landmarks to aid venous access

	Relevant anatomy	Technique
Internal jugular vein	Sedillot triangle: Formed by the medial (sternal) and lateral (clavicular) heads of the sternocleidomastoid muscle, and the clavicle inferiorly.	Place patient in Trendelenburg position. Puncture near the superior apex of triangle, angling toward the ipsilateral nipple at 30 to 45° in the sagittal plane.
Subclavian vein	The subclavian vein lies posterior to the medial third of the clavicle. The vein is best accessed immediately deep to the junction of the medial and lateral thirds of clavicle, which is recognizable by the inferior bend in the clavicle as you sweep your hand from lateral to medial.	Cutaneous puncture 2 cm inferior and lateral to genu of the clavicle. The needle is advanced parallel to the floor along a path, aiming approximately 1 cm superior to the sternal notch.
Femoral vein	The ideal site for femoral cannulation is just inferior to the inguinal ligament, which is roughly estimated by the inguinal skin crease. The mid-inguinal point between the anterior superior iliac spine and pubic tubercle localizes the femoral artery, which can be confirmed via pulsatile palpation. The femoral vein lies medial to the common femoral artery at this location.	Cutaneous puncture 2 cm inferior to the inguinal ligament and medial to the femoral pulse. Angle needle 30 to 45° and advance in the sagittal plane.

Courtesy of Houssam Younes, MD, FACS, FSVS, RPVI and Tony Lu, MD.

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