Terry

Hi, Currently work in Melbourne, Australia. US guided cannulation is being used with increasing frequency in paediatrics and anaesthesia. My experience with neonates is more limited, I've only really done it with supervision. As Tamimi states, the learning curve is steep- it's like going back to square one all over again. It's harder in neonates than with children I think, I feel like I need an extra arm. You do need a longer cannula, with the shorter one you run out of road. On the flipside, a 3cm line should stay in longer than a 1.9cm line. Unrelated to ultrasound- we have on occasion used a guidewire to upgrade a 1.4cm line, or a 26g cannula to a 24g 3cm cannula.

Familiarity with equipment is very important. There is little point having videolaryngoscopy at the bottom of your difficult airway algorithm, if the machine spends the year sat in the corner gathering dust. You need to be familiar with it, if you're going to call upon it in an emergency. The same goes for LMAs and guedels.