Abstract
A E 15-year-old female (weight 35 kg, height 140 cm) underwent surgical closure of an atrial septal defect while on ardiopulmonary bypass (CPB). After induction of anesthesia, annulation of the right internal jugular vein (RIJV) was atempted by Seldinger’s technique. Despite the vein being iniially located with a 22-G, 3.8-cm “finder” needle at the apex of he triangle formed by the sternal and the clavicular heads of he sternocleidomastoid muscle and the clavicle, no blood ould be aspirated at the expected depth with an 18-G cannula irected along the same track. Pushing the cannula deeper esulted in an arterial puncture. The cannula was pulled out and xternal pressure applied for 10 minutes. A subsequent attempt ith an 18-G cannula appeared successful in locating the RIJV y aspiration of nonpulsatile blood. The J-tip guidewire passed hrough the cannula after a slight initial resistance, and a 7.5F riple-lumen catheter (Multicath triple lumen; Vygon, New elhi, India) was threaded over it and sutured to the skin at 12
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