Central approach to the internal jugular vein

The central approach to cannulation of the internal jugular vein is most common. Insert the needle at the apex of the angle formed by the two heads of the sternocleidomastoid, lateral to the carotid artery pulsation, at an angle approximately 30 degrees from the skin. Direct the needle towards the ipsilateral nipple. Blood is usually aspirated within 2.5 cm of insertion. If blood is not aspirated while advancing, slowly withdraw the needle. Aspiration often occurs as the needle is pulled back.