Journal of Clinical Monitoring and Computing

, Volume 30, Issue 2, pp 221–225 | Cite as

Differences in anatomical relationship between vertebral artery and internal jugular vein in children and adults measured by ultrasonography

  • Katsuyuki Matsushita
  • Ken Yamaura
  • Yuji Karashima
  • Kozaburo Akiyoshi
  • Sumio Hoka
Original Research


Cannulation of the internal jugular vein (IJV) under ultrasound guidance can reduce complications, such as common carotid artery (CCA) puncture, accidental vertebral artery (VA) puncture. However, these complications still occur, especially in pediatric patients probably due to anatomical predisposition of VA. This study compared differences in anatomical location of VA and IJV between pediatric and adult patients. Children with body weight <20 kg (n = 16) and adults who required central venous or pulmonary arterial pressure monitoring (n = 21) were enrolled. After induction of general anesthesia and tracheal intubation, patients were positioned for IJV cannulation. Images of the right CCA, IJV and VA were recorded by ultrasonography. The size of each vessel, anatomical relationship of other vessels, distance between vessels and between each vessel and skin were measured. The size of VA relative to IJV was significantly larger in children than in adults (14 vs 7 %, P < 0.001). The absolute and relative distance between IJV and VA were significantly shorter in children than those in adults (P < 0.01). The anatomical relationships between IJV and CCA and that between IJV and VA were not different between children and adults. In children, VA was relatively larger and located closer to IJV than adults. The results call for careful attention to the position of VA during ultrasound-guided IJV cannulation especially in children.


Ultrasound-guided central venous cannulation Children Vertebral artery Complications Internal jugular vein 



The authors thank F.G. Issa, MD, PhD ( for the careful reading and editing of the manuscript. This study was supported by a Departmental Grant.

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Chuan WX, Wei W, Yu L. A randomized-controlled study of ultrasound prelocation vs anatomical landmark-guided cannulation of the internal jugular vein in infants and children. Paediatr Anaesth. 2005;15:733–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Parsons AJ, Alfa J. Carotid dissection: a complication of internal jugular vein cannulation with the use of ultrasound. Anesth Analg. 2009;109:135–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Grebenik CR, Boyce A, Sinclair ME, Evans RD, Mason DG, Martin B. NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? Br J Anaesth. 2004;92:827–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Sigaut S, Skhiri A, Stany I, Golmar J, Nivoche Y, Constant I, Murat I, Dahmani S. Ultrasound guided internal jugular vein access in children and infant: a meta-analysis of published studies. Paediatr Anaesth. 2009;19:1199–206.CrossRefPubMedGoogle Scholar
  5. 5.
    Kayashima K, Habe K. A case report of an accidental vertebral arterial puncture videotaped during central venous catheterization in a child undergoing a ventricular septal defect repair. Paediatr Anaesth. 2012;22:311–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Momiy J, Vasquez J. Iatrogenic vertebral artery pseudoaneurysm due to central venous catheterization. Proc Bayl Univ Med Cent. 2011;24:96–100.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Blaivas M, Adhikari S. An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med. 2009;37:2345–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Gwak MJ, Park JY, Suk EH, Kim DH. Effects of head rotation on the right internal jugular vein in infants and young children. Anaesthesia. 2010;65:272–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Qin XH, Zhang H, Mi WD. Anatomic relationship of the internal jugular vein and the common carotid artery in Chinese people. Chin Med J. 2010;123:3226–30.PubMedGoogle Scholar
  10. 10.
    Hong JY, Koo BN, Kim WO, Choi E, Kil HK. Effect of head rotation on overlap and relative position of internal jugular vein to carotid artery in infants and children: a study of the anatomy using ultrasonography. J Crit Care. 2010;25:360.e9–13.CrossRefGoogle Scholar
  11. 11.
    Roth B, Marciniak B, Engelhardt T, Bissonnette B. Anatomic relationship between the internal jugular vein and the carotid artery in preschool children—an ultrasonographic study. Paediatr Anaesth. 2008;18:752–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Yoon HK, Lee HK, Jeon YT, Hwang JW, Lim SM, Park HP. Clinical significance of the cross-sectional area of the internal jugular vein. J Cardiothorac Vasc Anesth. 2013;27:685–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Kayashima K, Ueki M, Kinoshita Y. Ultrasonic analysis of the anatomical relationships between vertebral arteries and internal jugular veins in children. Paediatr Anaesth. 2012;22:854–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Katsuyuki Matsushita
    • 1
  • Ken Yamaura
    • 2
    • 3
  • Yuji Karashima
    • 1
  • Kozaburo Akiyoshi
    • 2
  • Sumio Hoka
    • 1
  1. 1.Department of Anesthesia and Critical Care Medicine, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Operating RoomsKyushu University HospitalFukuokaJapan
  3. 3.Department of Anesthesiology, School of MedicineFukuoka UniversityFukuokaJapan

Personalised recommendations