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Sir, I read the article on fatal airway obstruction following arterial trauma during internal jugular venous cannulation by Williams et al. with great interest.[1] While arterial puncture is a known risk in central venous cannulations, I would like to bring to attention several points that were clearly to be highlighted. First of all, as a standard guideline, any elective central venous cannulation should be done under ultrasonic guidance. This is not technically difficult but has tremendously reduced the incidence of inadvertent arterial injury. Use of ultrasound also would point one toward arterial injury in case of doubt, as in this index patient. Color of the blood is not the gold standard to assess the nature of the vessel. Quite often, patients who require central venous cannulations are already unstable and their arterial blood can equally be dark as well to naked eye. When in doubt, one should always check saturations in blood aspirated from the vessel before attempting to dilate to great nature. As is always, if in doubt, dilatation should be barred, as a dilated neck artery would only need a surgical repair and is rare to get control in an elderly patient to stop on its own.

Acute multifocal dystonic reaction: An unusual presentation of vitamin D-deficient rickets