• Kenji Kayashima.
• Department of Anesthesia, Kyshukoseinenkin Hospital, Kitakyushu 806-8501.
• Masui. 2013 Feb 1;62(2):193-6.

AbstractA baby girl, 15-month-old, 75.6 cm in height, and 7.5 kg in weight, was scheduled to undergo ventricular septal defect repair. The right IJV, 3.0 mm in thickness and 7.0 mm in depth, was punctured to place a central venous catheter with a 19-mm-long 24G puncture needle. Non-pulsatile bright red blood appeared during the 15.8-mm-long needle insertion and dark red blood appeared during the 14.7-mm-long needle insertion. The vertebral artery, 3.9 mm in width, lay 14.1 mm in depth. The 15.8-mm-long needle inserted at a 45-degree angle could reach about 11.3 mm deep perpendicularly from the skin surface. The 14.7-mm-long needle inserted at a 45-degree angle reached about 10.4 mm, which is near the posterior wall of the IJV It seemed that a small artery behind the IJV was punctured mistakenly. In withdrawing blood from a cyanotic patient, it may be difficult to judge if the blood was arterial because it was non-pulsatile when it appeared. We should be careful to know the existence of small arteries behind IJVs and to confirm which vessels the returned blood comes from.

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