The external jugular vein (EJV) drains most of the blood from the face and scalp (Figure 1). It begins in the region of the parotid gland (usually as a result of conjunction of the posterior auricular and retromandibular veins). It then runs backwards and downwards (under the cover of platysma) across the surface of the sternomastoid. At this point it pierces the deep fascia and enters, in the majority of cases, the jugulo-subclavian confluence ¹. Less commonly it enters either the subclavian vein or internal jugular vein directly. A valve is frequently present at the junction of the EJV and the subclavian vein.

There appears to be an inverse correlation between the size of the external and internal jugular veins ² - thus the presence of a large EJV may be an indicator of a small IJV and therefore of potentially more difficult internal jugular venepuncture.

The EJV is occasionally used for access to the central circulation. - The route has the advantage of being relatively easy to venepuncture, but suffers from the drawback that the catheter has to traverse a circuitous route to gain entry into the superior vena cava. The presence of valves in the EJV system may also make the task of negotiating a PAC into the central circulation more difficult. Unlike all other veins used for PAC insertion, it has the advantage that it is not accompanied by a corresponding artery and that therefore the risk of arterial puncture is practically nil.

In general, it is a much less satisfactory approach than the common sites used for insertion of PA catheters (internal jugular approach and subclavian approach). It may be suitable for use in a heavily anticoagulated patient because it is easy to apply pressure to the site of venepuncture should a haematoma occur. Successful access to the central circulation via the EJV has been achieved in 90% of cases when the Seldinger technique is used ³.

1. Kopuz C, Akan H The importance of the angulation and termination of external jugular vein in central venous catheterization in newborn. Okajimas Folia Anat Jpn 1996 Aug;73(2-3):155-9

2. Stickle BR, McFarlane H Prediction of a small internal jugular vein by external jugular vein diameter. Anaesthesia 1997 Mar;52(3):220-2

3. Blitt CD, Wright WA, Petty WC et al: Cardiovascular catheterization via the external jugular vein. A technique employing the 'J' wire. JAMA 229:817-818, 1974

Last edited on: 12/11/2000