[A case report of a failure to advance a guidewire in an infant from the internal jugular vein to the brachiocephalic vein].

A 2-month-old baby boy, 52 cm in height and weighing 4.6 kg, underwent a Blalock-Taussig shunt operation under general anesthesia. The authors checked the internal jugular vein (IJV) using an ultrasound apparatus with a 5/10-MHz probe (TiTAN, SonoSite Co., Tokyo, Japan) at a mid-portion of the neck. We observed a 3.9-mm-wide and 7.6-mm-deep IJV for central venous catheter (CVC) placement. We started to videotape the procedure. The operator punctured the IJV using real-time ultrasound guidance with a 24 G plastic puncture needle (Jelco Plus, Smith Medical, Tokyo, Japan), and obtained the back flow of the vein. The operator could not advance a guidewire more than 5 cm into the IJV. We suspected that the straight type guidewire had advanced outside of the IJV, and removed the guidewire. We placed the CVC into the left IJV instead of the right IJV. We speculated that the guidewire had advanced into the IJV; however, we could not advance the tip of the guidewire from the IJV to the brachiocephalic vein because the angle between the IJV and the brachiocephalic vein was 90 degrees. We could have advanced a J-type guidewire from the IJV into the brachiocephalic vein.