Subclavian Central Venous Catheterization in Neonates: Experience in a Medical Center

Abstract

Objectives: Central venous access is an important aspect of medical treatment in the neonatal intensive care unit (NICU). Central venous lines (CVLs) are needed for cardiac catheterization, total parenteral nutrition (TPN), intravenous antibiotics, multiple transfusions, and chemotherapy. The primary aim of this study was to demonstrate that central venous catheterization in neonates could be done through the subclavian vein as an alternative to the femoral vein. Methods: In our NICU, we always try to insert CVLs through the femoral vein first. When multiple attempts fail in the femoral area, we then approach the subclavian vein. Between January 1999 and June 2004, we performed a total of 20 subclavian vein catheterizations (SVC) in 18 neonates who weighed between 2.2 kg and 4.8 kg. Results: We had a success rate of 80% (16/20). Ten of the 16 successful insertions were done in 2 attempts and three sustained arterial punctures. In the 4 failed insertions, 1 patient had a pneumohemothorax and 3 had arterial punctures. Conclusions: In our NICU, we need intact femoral veins for cardiac catheterization. Excessive femoral vein catheterizations (FVC), however; often result in thrombosis, stricture, and hematoma which complicate subsequent FVC attempts. In this study we found subclavian venous catheterization in neonates could be used as an alternative procedure.