Abstract
In a 33-month-old boy, 86 cm in height and 9.6 kg in weight, a resident anesthesiologist punctured a 5.1-mm-wide and 3.9-mm-thick internal jugular vein (IJV) for central venous catheterization using an ultrasound apparatus with a 5/10 MHz probe. She advanced a 0.018-inch guidewire through the outer needle, and failed to insert it into the IJV at the first attempt. We found that the IJV narrowed to 2.0 mm in width 2 minutes after neck compression for hemostasis. The operator failed to insert the needle through the 2.0-mm-wide IJV at the second attempt. The IJV increased to 3.6 mm in width 7 minutes after the first appearance of the venous spasm. The operator successfully punctured the IJV 13 minutes after starting the first puncture, and inserted the guidewire into the IJV at the third attempt. We speculated that the reason why the diameter of the IJV decreased was the vessel spasm because there was little evidence of hematoma, vascular intima injury, thrombus, or compression.
