Figure 32-21 Technique for central venous cannulation of the right internal jugular vein. A, Important surface landmarks are identified. B, The course of the internal carotid artery is palpated. C, The internal jugular vein is punctured at the apex of the triangle formed by the two heads of the sternocleidomastoid muscle, with the needle tip directed toward the ipsilateral nipple. D, A guidewire is introduced through the thin-walled needle into the vein. E, The central venous cannula is inserted over the guidewire while making sure that the proximal end of the guidewire protrudes beyond the catheter and is controlled by the operator.