Percutaneous Central Venous Catheterization in Infants <4.0 kg

We read with interest the article by Iwaski et al. [2]. An initial failure rate of approximately 48% is described for internal jugular catheterization in infants less than 4 kg body weight. Although there is likely to be institutional variation, we agree that internal jugular catheterization is more difficult in smaller infants when anatomical landmarks are used to locate the vein. Increased difficulty results from the smaller caliber of the vein, the short neck, and the increased mobility of the vein. We also believe that (when not specifically contraindicated) internal jugular catheterization is the preferred method of central venous catheterization in small infants due to the larger size of the internal jugular vein compared to lower limb veins and the relatively superficial position of the vein. Using real-time two-dimensional ultrasound to