[Successful internal jugular venipuncture in an infant with a high risk of puncturing the vertebral artery].

A five-month-old baby girl, 61.8 cm in height and weighing 4.9 kg, underwent ventricular septal defect repair under general anesthesia. Authors checked for small vessels around the IJV using an ultrasound echo apparatus with a 5/10-MHz probe (TiTAN, SonoSite Co., Tokyo, Japan) at a point 28 mm from the clavicle over the IJV. We observed a 3.8-mm-wide and 8.7-mm-deep vertebral artery 1.3 mm behind the 5.5-mm-wide IJV with color Doppler flow imaging for CVC. It seemed difficult to avoid puncturing the vertebral artery. We checked for small arteries again at a point 40 mm from the clavicle. We also confirmed the 3.2-mm-wide and 13.4-mm-deep vertebral artery 5.3 mm behind the IJV. It thus seemed possible to avoid puncturing the vertebral artery at this point. The operator punctured the IJV carefully using real-time ultrasound guidance with a 24 G plastic puncture needle (Jelco Plus, Smith Medical, Tokyo, Japan), and avoided puncturing the vertebral artery. The CVC was successful, and no after-effect was observed following the operation. Before inserting the puncture needle each time, one should check for small arteries behind the IJV with color Doppler flow imaging.