The paper by Tripathi and Pandey [1] presents a useful manoeuvre to increase the cross-sectional area of the internal jugular vein (IJV) and thereby facilitate its cannulation. In my opinion, this technique may be especially useful in patients where the left IJV is being cannulated, as this vessel has been shown to have a significantly smaller cross-sectional area compared with the right IJV in a third of adults [2]. Tripathi and Pandey omit to mention in their paper, however, whether the 22-G pilot puncture needle remained in-situ when the guide wire was threaded through the wide bore (18-G) needle. I trust that was not the case, but if it was, would it not then increase the risk of the guide wire snagging or shearing against the 22-G needle? Although the authors described various manoeuvres to distend the IJV such as the 10° head-down position, the application of positive airway pressure and a Valsalva manoeuvre, the use of hepatic compression to achieve a similar outcome should be added to this list [3].


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