In-plane ultrasound imaging of the vertebral artery for safe pediatric internal jugular vein cannulation.

Before cannulation of the internal jugular vein (IJV) in 4 pediatric patients, we obtained in-plane and out-of-plane ultrasound images of the vertebral artery (VA). In 2 of 4 patients, abnormalities were identified and best imaged in the in-plane view. In one patient, the right VA had an anomalous origin and course behind the IJV. In another patient, the in-plane image of both the IJV and the VA clearly showed a narrowed IJV. In some cases, the relationship between the VA and IJV may be more clearly understood with in-plane imaging.