Abstract
The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. This article gives an overview of the current use of US for achieving central venous catheter placement in the SCV or the brachiocephalic vein (BCV) in neonates. More than 1,250 catheters have been reported inserted in children and neonates for a cumulated success rate of 98.4% and the complication rate is reported to be low. The technical aspects of various approaches are discussed, and we offer our recommendation of an US-guided technique for SCV and BCV cannulation based on our experience in a large NICU setting. Although the cannulation the SCV or BCV does not substitute the use of peripherally inserted central catheters or umbilical venous central catheters in neonates, it is a feasible route in very small children who are in need of a large caliber central venous access.
Highlights
Central vascular access is frequently required in critically ill children
Despite the routine aspect of placing central venous catheter (CVC) in NICU and PICU units, the procedure is still associated with complications such as accidental arterial puncture, hematomas, pneumothorax, catheter malposition, and failure of cannulation [3]
Central venous access (CVA) in smaller children remains technically challenging even in experienced hands [4] and there is an ongoing demand for optimization of catheterization and subsequent management or any immediate catheter-associated complication, including catheter misplacement
Summary
Central vascular access is frequently required in critically ill children. It is often an everyday procedure in NICU and PICU units, where percutaneous non-tunneled central catheters are used in urgent, or short-term situations and can remain in place for up to 2 weeks [1]. In acutely ill neonates, a large central venous catheter (CVC) is often warranted. These catheters have a wide range of indications including resuscitation with the need for administration of fluids and vasoactive drugs, the need for prolonged parental nutrition, the need for very frequent blood samples, and when venous access cannot be achieved otherwise. In recent years, an increasing number of data supporting the use of US-guided SCV cannulation in children and neonates has been published (Table 1)
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