IJV Landmark — FRCA Primary MCQ
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Correct answer: E — The apex between the sternal and clavicular heads of sternocleidomastoid
The correct answer is E. The traditional central landmark approach uses the apex of Sedillot's triangle, where the sternal and clavicular heads of sternocleidomastoid diverge; the clavicle forms the triangle's base. This is a surface puncture landmark rather than a guarantee of the vein's precise position, because the internal jugular vein and sternocleidomastoid anatomy vary. The angle of the mandible relates to the upper course of the internal jugular vein but is not the central-approach puncture point. Trapezius and the posterior triangle are associated with posterior neck anatomy and alternative approaches, while the suprasternal notch is a midline landmark. In current UK practice, real-time two-dimensional ultrasound is preferred for internal jugular cannulation and should be used to identify the vessel and adjacent carotid artery.
Reference: Dunne H, Abou-Abdallah M, Robinson M, et al. Should Sedillot's triangle be used for central venous cannulation? A cadaveric study. Clinical Anatomy. 2023. https://pubmed.ncbi.nlm.nih.gov/36708178/