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Frequently patients do not have large internal jugular veins to target for a central venous catheter. In the case of a small vessel such as this one, the first step is to evaluate the other side of the neck to see if it is a larger target. If that is not possible, then ensuring that the vein is lateral to the artery (as in this video), instead of anterior to the artery, becomes essential to decrease risk of arterial puncture.