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The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve. It begins in the posterior compartment of the jugular foramen, at the base of the skull.
The left and right external jugular veins drain into the subclavian veins. The internal jugular veins join with the subclavian veins more medially to form the brachiocephalic veins. Finally, the left and right brachiocephalic veins join to form the superior vena cava, which delivers deoxygenated blood to the right atrium of the heart. [2]
The carotid sheath is a condensation of the deep cervical fascia [1]: 578 enveloping multiple vital neurovascular structures of the neck, [2] including the common and internal carotid arteries, the internal jugular vein, the vagus nerve (CN X), and ansa cervicalis. [1]: 578 [2] The carotid sheath helps protects the structures contained therein. [2]
The Trendelenburg position is also used when placing a central venous catheter in the internal jugular or subclavian vein. The Trendelenburg position uses gravity to assist in the filling and distension of the upper central veins, as well as the external jugular vein. It plays no role in the placement of a femoral central venous catheter. [7]
The patient is positioned at a 45° incline, and the filling level of the external jugular vein determined. [1] The internal jugular vein is visualised when looking for the pulsation. In healthy people, the filling level of the jugular vein should be less than 4 centimetres vertical height above the sternal angle. [2]
Just above the sternum the two anterior jugular veins communicate by a transverse trunk, the jugular venous arch (or venous jugular arch), which receive tributaries from the inferior thyroid veins; each also communicates with the internal jugular. There are no valves in this vein.
It receives blood from the external palatine vein before it either joins the anterior branch of the retromandibular vein to form the common facial vein, or drains directly into the internal jugular vein. There are valves in the facial vein. [1] Its walls are not so flaccid as most superficial veins.
Typically, there are two trunks - one on each side of the body. The right bronchomediastinal trunk may connect the right lymphatic duct, and the left trunk to the thoracic duct, [1] although more frequently, they open independently into the junction of the internal jugular vein and subclavian veins on their respective sides.