Sir-The recent article of Sigaut et al. (1) and subsequent correspondence (2,3) highlights the controversy surrounding the question whether or not real-time ultrasound guidance improves the success rate and/or prevents complications during internal jugular vein (IJV) cannulation in pediatric patients. However, what appears to be overlooked is the benefit of a pre-insertion ultrasound evaluation in preventing attempted IJV cannulation when success would be impossible. Reported here is the absence of a right IJV noted during ultrasound evaluation prior to attempted cannulation.A 12-year-old, 29.9-kg, patient presented for posterior spinal fusion and instrumentation secondary to neuromuscular kyphoscoliosis. She was born prematurely at 26-week-gestation with subsequent cerebral palsy and global developmental delays, but had no history of extracorporeal membrane oxygenation, previous central line placement or congenital vascular malformations. After induction of general anesthesia, peripheral venous access was obtained, the patient was intubated, and an arterial line placed.
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