Children are placed in a light head-down position. A standard sized towel roll is placed under the shoulders. The patient’s head is turned 45° to the side opposite to the cannulation (BCV-Clip 2).

The operator positions himself next to the left side of the child’s body while facing the head of the patient when attempting to cannulate the left brachiocephalic vein (BCV). The ultrasound (US) screen is placed next to the infant’s head on the left hand side. This enables an almost concomitant view of both the patient’s anatomy as well as the US image while holding the US probe in the one hand and maneuvering the needle or i.v. cannula without attached syringe with the other hand. For the cannulation of the right BCV the operator is positioned at the child’s head while facing the body of the patient and the US screen is placed next to the right side of the infant’s body.  An US device with a 13-6 MHz, 25-mm broadband linear array transducer (M-Turbo, Sonosite, Inc., Botholl, WA, USA) and a depth of 1.9 cm can be used. Depending on the operator’s preference a 4 cm 21-gauge needle (Arrow; Arrow international, Inc.; Reading, PA) or 32 mm, 22-gauge i.v. cannula (Abbocath; Arnsino Medical (Shanghai) Co., Ltd; Shanghai, China) or 25 mm, 22-gauge i.v. cannula (Jelco; Smiths Medical International Ltd, Rossendale, Lancashire, UK) are chosen. The US probe is placed in the supraclavicular region so as to obtain a good longitudinal view of the BCV (BCV-Figure 1xxx) (1). Using a strict in-plane technique the needle or i.v. cannula is then guided from lateral to medial under direct US vision into the BCV (BCV fig.1xxx, BCV-clip 1xxx,  BCV-clip 2xxx, BCV-clip3xxx). If there is a good spontaneous return of blood flow via the needle the US probe is withdrawn and a J-shaped 0.018 inch (0.46 mm) guide-wire (Arrow or Cook inc.; Bloomington, In, USA) is introduced into the vein. In the case of an i.v. cannula the needle is withdrawn as soon as a spontaneous return of blood flow is noted and the cannula advanced over the needle into the vein. If according to the US image the tip of the needle or i.v. cannula is believed to be inside the vein without a spontaneous return of blood flow, a syringe is attached in order to try to aspirate blood while slowly withdrawing the needle or i.v. cannula. After successful blood aspiration the guide-wire is introduced into the vein. If blood cannot be aspirated the US probe is replaced and the tip of the needle is redirected into the vein under direct US vision. Finally a 2-French single lumen catheter (Seldiflex; Plastimed; Saint-Leu-La-Foret, France) or 4-French double lumen catheter (Arrow) is threaded into the vein via the guide-wire and fixed on the patients’ shoulder.