[Left internal jugular venipuncture in real-time ultrasound-guided pediatric central venous cannulation]

The right internal jugular vein (IJV) is usually selected for pediatric central venous cannulation (CVC); however, the left is rarely selected. We investigated cases of CVC through left IJVs from Apr to Nov of 2011. In all 82 patients with the median age of 11 months, height of 72.2 cm, and weight of 7.4 kg, right IJVs were selected first for real-time ultrasound-guided CVC. Right IJVs were with median width of 7.3 mm, length of 5.0 mm, and depth of 6.8 mm. After three failed attempts through the right IJVs in three patients (3.7%), of 2 to 9 months of age out of the 82 patients, 24 G puncture needles were successfully inserted through left IJVs with the first attempt. One of the three patients, of 9 months of age with a persistent left superior vena cava, had a thinner 2.6-mm-wide right IJV and a thicker 8.3-mm-wide left IJV It was difficult but successful to insert a 0.018-inch guidewire in another patient due to a steep 90 degree angle between the left IJV and the brachiocephalic vein.