Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients.

Percutaneous cannulation of the internal jugular vein in paediatric patients may be technically difficult and is prone to complications. To investigate the possibility that anatomical factors contribute to these difficulties, we used a two-dimensional ultrasound scanner to examine venous anatomy in children aged up to 6 yr. We found that 18% of our children had anomalous venous anatomy that may account for some of the difficulties reported previously. The diameter of the internal jugular vein was predicted poorly by the patient's age (r2 = 0.259) or weight (r2 = 0.155). We also evaluated the use of this ultrasound scanner during percutaneous central venous cannulation in neonates and infants. Determining the course of the internal jugular vein with the scanner and then marking it on the overlying skin reduced both the time and number of needle insertions required to aspirate jugular venous blood and increased the chance of a complication-free cannulation.