Bevel up or down for IJ central lines?

12 Feb

Lim T, Ryu H-G, Jung C-W, Jeon Y, Bahk J-H. Effect of the bevel direction of puncture needle on success rate and complications during internal jugular vein catheterization*. Critical Care Medicine. 2012 Feb.;40(2):491–494.  PMID 21983370


  • elective thoracic surgery pts
  • US guided
  • measurements by consultant, lines by a resident
  • randomised bevel up or down
  • end point was rate of post wall haematoma by US after the procedure- and this is the key point – there’s no definition of what a haematoma was. They give a picture as an example but I don’t know what it means
Left = Normal; Right = haematoma


  • n = 338
  • 6 v 17 post wall haematomas favouring bevel down approach
  • rates of success and everything else equal


So it seems bevel down is better. Though it worries me that there was no attempt to define what a haematoma is.

I suspect (though I honestly wouldn’t be sure) that I’m a bevel up person normally, but this would make me think of changing my mind.

2 Replies to “Bevel up or down for IJ central lines?

  1. IMO for kids I find bevel down gets me info about flash back quicker and I go thru the wall less often. What do others think?

  2. Pingback: R&R In The FASTLANE 011 • LITFL

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