For internal jugular vein central venous cannulation at the apex of the anterior triangle, the needle is directed at 30 degrees to the skin towards the ipsilateral nipple. Which structure is most at risk of inadvertent puncture with this approach if the needle is inserted too laterally?

• A Subclavian artery
• B Thoracic duct (on the left side)
• C Phrenic nerve
• D Common carotid artery ✓

Explanation

The internal jugular vein (IJV) lies lateral to the common carotid artery within the carotid sheath. During IJV cannulation at the apex of the anterior triangle (between the sternal and clavicular heads of sternocleidomastoid), lateral needle deviation can puncture the common carotid artery, causing haematoma, arteriovenous fistula, or rarely, pseudoaneurysm. The thoracic duct is specifically at risk only on the left side, where it arches over the subclavian artery before draining into the left venous angle, and is an important complication of left-sided procedures causing chylothorax.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.