Twenty-eight elderly patients underwent central venous catheterization via the external jugular (EJ) vein before surgery. Plain chest X-P provided the position of the tip of catheter, and via the image of the catheter on film the confluent angle of the EJ vein into the subclavian vein was measured. The catheter was successfully positioned into the central vein of twenty-six patients (93.1%), excepting two patients who were found to have malpositioned tip entry. This success rate was much higher than any other previous reports. No complications accompanied the catheterization, such as accidental pneumothorax and carotid puncture. This data shows that our catheterization maneuver is safe and reliable. The confluent angle of the EJ vein into the subclavian vein ranged from 33 to 136 degrees, and the mean value was 78.6±29.5 degrees. The angles of eleven patients (37.9%) were more than 90 degrees, which means those EJ veins flowed into the subclavian vein from the brachial side. This data suggests that the lower success rate of this route via the EJ vein, compared with via the subclavian vein, was attributed to this anatomical variation.
