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[Music] step one is to be prepared with your sterile tray with necessary equipment and medication before you start the procedure take sll septic precautions before starting the procedure the patients head should be turned away from the side on which the ijv is being accessed so as to provide optimal access to that side of the neck having an assistant hold the patients head in that position is often necessary turning the patients head to the side also makes the sternocleidomastoid more prominent and makes the landmarks easier to identify step two is to palpate the carotid pulsation to identify the sternocleidomastoid muscle palpate triangle made by the clavicle and sternal and clavicular heads of the sternocleidomastoid muscle to identify the location of the internal jugular vein usually the insertion point is at starting between two heads of sternocleidomastoid muscle or about 1.5 centimeter lateral to carotid pulsation the next step is to anesthetize the skin at the apex of the tr