If unable to tolerate trendelenberg and on mechanical or non-invasive ventilation consider raising PEEP as this may increase diameter of IJ making for an easier target
Same preparation as above, differences from ultrasound method highlighted below
Rotate head 15-30 deg away from target side
Anterior approach
Insert needle along medial edge of SCM, 2-3 finger breadths above clavicle
Entry angle 30-45 deg
Aim towards ipsilateral nipple
Central approach
Insert needle at the apex of the triangle formed by the heads of the SCM and the clavicle
Entry angle 30 deg
Aim towards ipsilateral nipple
Posterior approach
Insert needle at the posterior (lateral) edge of the SCM, halfway between the mastoid and the clavicle
Entry angle 45 deg
Aim for the suprasternal notch
Insert needle along medial edge of SCM, 2-3 finger breadths above clavicle
Entry angle 30-45 deg
Aim towards ipsilateral nipple
Insert needle at the apex of the triangle formed by the heads of the SCM and the clavicle
Entry angle 30 deg
Aim towards ipsilateral nipple
Insert needle at the posterior (lateral) edge of the SCM, halfway between the mastoid and the clavicle
Entry angle 45 deg
Aim for the suprasternal notch
Central line: internal jugular
Central line: subclavian
Central line: femoral
Central line: supraclavicular
Central Line: removal
Arterial line
Ultrasound: Pharyngeal
Nine line CASEVAC