“Central venous catheterization (CVC) is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration. CVC is widely used in the emergency department and intensive care units. It is typically performed by inserting a catheter through the internal jugular vein (IJV) into the superior vena cava near the right atrium. While catheterization is a fundamental skill proficiently performed by healthcare professionals, lethal complications may occasionally occur because of undesirable positioning, depth and diameter.

Typically, the IJV is located approximately 1 cm beneath the neck skin. It can be accessed through a central approach by puncturing the apex of Sedillot’s triangle, formed by the sternal and clavicular heads of the sternocleidomastoid muscle and clavicle, toward the nipple on the same side. The anatomy of the IJV is generally stable. However, variations of the IJV, have been reported in the incidence between 0.4% and 3.3%. In 2007, Downie et al defined two types of variations: duplication and fenestration. For a more standardized approach, Mumtaz et al proposed distinguishing bifurcation from duplication depending on the branching position and presented two new types: trifurcation and posterior tributary. “

Shan Y, Huang W. Anatomical variation in the internal jugular vein: potential risk factors for central venous catheterization – a case report. World J Emerg Med. 2024;15(4):316-318. doi: 10.5847/wjem.j.1920-8642.2024.056. PMID: 39050210; PMCID: PMC11265632.