Question 23

Outline the anatomy of the internal jugular vein relevant to central venous line
cannulation (80% of marks). Include important anatomical variations (20% of marks).

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College Answer

Good answers were structured including origin, termination, tributaries, relationships, surface
anatomy and common variations.
Factual inaccuracies were common and there was confusion about the relations of the internal
jugular vein. Many candidates did not mention the changing relationship between the internal
jugular and the carotid artery as they travel through the neck or the changes that result from
repositioning for insertion. Many candidates also forgot to mention surface anatomy and a
number talked about ultrasound and views used for insertion of central lines. Common
omissions included the origin, tributaries, relationship with the correct cranial nerves and the fact
that it is usually larger on the right. Almost nobody mentioned the relationship to the pleura.