During internal jugular vein (IJV) central venous cannulation using the central approach, the needle is inserted at the apex of which triangle, directed towards the ipsilateral nipple?

• A Posterior triangle of the neck, lateral to the lateral border of sternocleidomastoid
• B Triangle formed by the two heads (sternal and clavicular) of sternocleidomastoid and the clavicle ✓
• C Anterior triangle of the neck, medial to the medial border of sternocleidomastoid
• D Supraclavicular fossa between the clavicle, posterior border of SCM, and anterior border of trapezius

Explanation

In the central approach to IJV cannulation, the needle is inserted at the apex of the small triangle formed between the sternal and clavicular heads of the sternocleidomastoid (SCM) and the clavicle, at the level of the thyroid cartilage. The needle is directed toward the ipsilateral nipple at 45° to the skin. This approach ensures the IJV is medial to the SCM and lateral to the common carotid artery. The posterior approach uses the posterior border of SCM but carries higher risk of pneumothorax. The supraclavicular fossa is the approach for subclavian vein access.

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

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Written and medically reviewed by the StethoPrep medical team.