• Ayumi Uno, Satoru Tanaka, Makoto Kanno, Yoshiya Ishioka, Masanori Watanabe, and Michiaki Yamakage.
• Masui. 2015 Apr 1;64(4):383-7.

BackgroundAccidental puncture of a vertebral artery can occur through the internal jugular vein during central venous catheterization.MethodsWe evaluated the anatomical relationships between vertebral arteries and internal jugular veins in one hundred adult patients under general anesthesia using echo image.ResultsThe vertebral artery could be observed in all patients under the level of cricoid cartilage. Vertebral arteries ran in an outward direction toward the caudal side (3.9 mm lateral and 14.6 mm deep from the internal jugular vein : median). Mean width of vertebral artery was 4.2 mm. Because the width of central venous catheter guide wire is approx. 1 mm, accidental puncture of a vertebral artery can occur through the internal jugular vein during central venous catheterization. By the use of ultrasound analysis, the vertebral artery could be observed completely.ConclusionsIt is important to identify the location of vertebral arteries under the level of cricoid cartilage and avoid the tap toward the lateral side. We can avoid accidental puncture of vertebral artery by taking care of these points.

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