Nasal Noninvasive Ventilation Research Articles

Summary of the best evidence for the prevention of nasal injury in preterm infants with nasal noninvasive ventilation.

Due to immaturity, the nose of preterm infants can easily be injured, by even a short application of a nasal device. However, 20% to 60% of preterm infants suffer nasal damage while using nasal continuous positive airway pressure (NCPAP) due to weak skin tissue, prolonged use of nasal device, and improper nursing practices, leading to increased risk of infection and decreased compliance and tolerance. In this study, we retrieved, obtained and integrated the related evidences of prevention of nasal injury in premature infants with nasal noninvasive ventilation to provide reference for clinical practice. We searched the relevant guidelines, expert consensus, evidence summaries and systematic reviews in the databases and guideline websites of the National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), the Agency for Health care Research and Quality (AHRQ), Guidelines International Network (GIN), the World Health Organization (WHO) guideline websites, Registered Nurses' Association of Ontario (RANO), Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), European Pressure Ulcer Advisory Panel (EPUAP), Yi Maitong, British Medical Journal best-practice, Cochrane Library, UpToDate, Embase, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang. The search was limited to the time of library establishment to February 2023. In total, 16 articles were included, including six guidelines, three expert consensuses, two evidence summaries and five systematic reviews. Twenty-eight pieces of evidence were summarized from six aspects: risk assessment, ventilation and connection, skin protection, skin assessment, training and support, and continuous quality improvement. This study summarized the best evidence for the prevention of nasal injury in premature infants through nasal noninvasive ventilation. It is suggested that nurses should consider the actual clinical situation when applying the suggestions from the evidence, formulate corresponding nursing measures, and reduce the occurrence of nasal injury in premature infants.

Outpatient Utilization of the RAM Cannula for Nasal Noninvasive Ventilation in Children.

The RAM cannula® consists of nasal prongs that can be used to administer oxygen, continuous, and bilevel positive airway pressure therapies. Studies have reported the efficacy and utility of the RAM cannula in inpatients requiring noninvasive ventilation (NIV); however, there is limited literature on the use of the RAM cannula to provide NIV in the outpatient setting. This study aimed to describe the clinical features and outcomes of children who used NIV via RAM cannula in the outpatient setting. Retrospective review. We conducted a retrospective review of children treated with outpatient NIV via RAM cannula at our institution between January 2010 and March 2023. The analyzed data included age, diagnoses, indications for NIV, duration of RAM cannula use, complications, and outcomes at 6 months. We identified 20 patients who used outpatient NIV via RAM cannula during the study period. The median age at initiation of NIV via RAM cannula was 5.8 months (IQR 2.4-9.9 months). Indications for NIV included sleep-related hypoventilation (15%), restrictive lung disease (25%), obstructive sleep apnea (45%), and chronic respiratory failure (50%), with 6 patients having ⩾2 indications for NIV. RAM cannula was utilized for inability to tolerate conventional NIV interfaces (80%), to alleviate dyspnea (60%), and to avoid tracheostomy (55%). Patients used NIV via RAM cannula for a median duration of 7.7 months (IQR 3.7-20.6 months). Patient outcomes included ongoing usage of RAM cannula (55%), changing to conventional NIV interfaces (15%) or oxygen (10%), weaning off respiratory support (5%), and death (15%). There were no complications related to using the RAM cannula. Our study demonstrates the utility of outpatient NIV via RAM cannula in children with a variety of diagnoses until clinical improvement or tolerance of conventional interfaces, and for avoidance of tracheostomy.

Mesh nebulizers enabling transnasal pulmonary delivery of medical aerosols to infants and toddlers: Roles, challenges, and opportunities

The development of mesh nebulizer technology has expanded the ability to deliver medical aerosols to infants and small childrenvianasal cannula and prongs. Mesh nebulizers do not require compressed gas to generate aerosols and have a smaller, lighter profile facilitating placement in delivery circuits, unlike ultrasonic nebulizers. Prior to this century, aerosol delivery with the nasal interface to 1–4 kg infants or surrogate animal models was limited to low single-digit deposition.In vitroand animal studies with the enabling mesh technology increase inhaled dose by upwards of 14% when nasal continuous positive airway pressure ventilation is in use. Recently, investigations of transnasal aerosol delivery to the lung have expanded to include nasal cannula interfaces with both high and low flow oxygen administration, nasal continuous positive airway pressure therapy, and nasal noninvasive ventilation in treating respiratory distress, respiratory insufficiency, and acute respiratory failure of infants and toddlers. We will first examine the progression of testing transpulmonary delivery of medical aerosols fromin vitromodels toin vivoanimal and human studies. Then, we will explain current and developing applications in clinical practice to view future directions and opportunities.

Clinical aspects of using non-invasive nasal ventilation in patients after COVID-19 complicated by bilateral multisegmental pneumonia

A clinical experience of using non-invasive nasal ventilation in patients after coronavirus disease 2019 (COVID-19) complicated by bilateral multisegmental pneumonia. It has been shown that, against the background of medication therapy, there is a restoration of ventilation-perfusion relationships in lung atelectasis areas, which is confirmed by spirometry and chest computed tomography. Implementation of non-invasive nasal ventilation against the background of drug therapy to restructure diffuse pulmonary fibrosis allows to accelerate the onset of dynamic exercise due to improved exercise tolerance.

Amyotrophic Lateral Sclerosis and Noninvasive Positive Pressure Ventilatory Support: "Nasal Noninvasive Ventilation" or "Noninvasive Ventilatory Support"?

Many studies suggest a brief statistical benefit on survival and quality of life by using nasal noninvasive ventilation for patients with amyotrophic lateral sclerosis and other neuromuscular conditions. Indeed, nasal noninvasive ventilation has become synonymous with continuous positive airway pressure and lo-span bilevel positive airway pressure. Nasal noninvasive ventilation, however, may not normalize CO2 levels and continuous positive airway pressure and O2 exacerbate hypercapnia and often lead to CO2 narcosis, intubation, and ultimately tracheostomy or palliative care death. However, a third option can be to offer up to continuous noninvasive ventilatory support and extubation to it. Noninvasive ventilatory support can be effective for full, definitive ventilatory support, even for people with no measurable vital capacity, and has maintained classic amyotrophic lateral sclerosis patients for up to 12 yrs without resort to tracheotomies. Nineteen centers have reported 335 amyotrophic lateral sclerosis patients using continuous noninvasive ventilatory support instead of tracheostomy mechanical ventilation for an average of 14 mos (6 mos to 14 yrs). The noninvasive ventilatory support must also be used in conjunction with mechanical insufflation-exsufflation to clear airway debris and normalize or renormalize ambient air oxyhemoglobin saturation, both to avoid intubation and to facilitate extubation. People with amyotrophic lateral sclerosis satisfying specific criteria, even when continuously dependent on tracheostomy mechanical ventilation, can be decannulated and placed on continuous noninvasive ventilatory support with mechanical insufflation-exsufflation.

Continuous noninvasive ventilatory support outcomes for patients with neuromuscular disease: a multicenter data collaboration

BackgroundTypically, patients with progressive neuromuscular disorders (NMDs) develop acute respiratory failure (ARF), are intubated, and when failing spontaneous breathing trials (SBTs) undergo a tracheotomy and receive tracheostomy mechanical ventilation (TMV). However, increasing numbers of patients use nasal noninvasive ventilation (NIV), initially for sleep and this is extended to continuous dependence (CNVS). This can be used as a strategy to assist in successful extubation . We retrospectively reviewed 19 centers offering CNVS and mechanical insufflation-exsufflation (MI-E) as an alternative to TMV. MethodsCenters with publications or presentations concerning CNVS outcomes data were pooled for amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD), and spinal muscular atrophy type 1 (SMA1). Progression to CNVS dependence without hospitalization, duration of dependence, and extubations and decannulations to CNVS were recorded. Prolongation of life was defined by duration of CNVS dependence without ventilator free breathing ability (VFBA). ResultsThere were 1623 part time (<23 h/day) NVS users with ALS, DMD, and SMA1 from 19 centers in 16 countries of whom 761 (47%) were CNVS dependent for 2218 patient-years. This included: 335 ALS patients for a mean 1.2 ± 1.0 (range to 8) years each; 385 DMD patients for 5.4 ± 1.6 (range to 29) years; and 41 SMA1 patients for 5.9 ± 1.8 (range to 20) years. Thirty-five DMD and ALS TMV users were decannulated to CNVS and MI-E. At data collection 494 (65%) patients were CNVS dependent but 110 (74 of whom with bulbar ALS), had undergone tracheotomies. ConclusionsALS, DMD, and SMA1 patients can become CNVS dependent without requiring hospitalization but CNVS cannot be used indefinitely for many patients with advanced upper motor neuron diseases.

Application of a photoelectric magnifier to nasal injury in preterm infants receiving non-invasive ventilation: A prospective observational study

PurposeThis study was to explore a photoelectric magnifier assessing nasal injury in preterm infants receiving non-invasive ventilation (NIV) treatment, and to describe the occurrence status and risk factors of nasal injuries. DesignA prospective observational study. Subjectsand setting: Preterm infants admitted from the Second Affiliated Hospital of Wenzhou Medical University between October 2018 and October 2019. MethodsA continuously convenient sample of 127 preterm infants was included. When the infants were receiving NIV treatment, nursing staff checked nasal skin and mucosa daily with a photoelectric magnifier to confirm whether nasal injuries occurred. Meanwhile, a self-designed questionnaire was used to collect data. The Chi-square test, t-test, univariate and multiple logistic regression model were applied. ResultsA total of 127 preterm infants received 175 times NIV therapy, showing that the incidence of nasal injuries (infants number) was 27.6% (35/127) and the incidence of nasal injuries (ventilation cases) was 21.1% (37/175). Of the 37 cases of nasal injuries, 27 cases were I stage, while Ⅱ stage, Ⅲ stage and mucosa injuries appeared 2 cases, 2 cases and 6 cases. In the multivariate logistic analysis, nasal mask interface and NIV treatment more than seven days were independent risk factors affecting the occurrence of nasal injuries. ConclusionsThe premature infants who received nasal NIV treatment were susceptible to nasal injuries, and clinical nurse capable of identifying risk factors and inintervening should be strengthened to prevent the occurrence and progression.

Respiratory treatment in a patient with nemaline myopathy.

Respiratory involvement of nemaline myopathy is evident on the diaphragm and intercostal muscles function. The present case study aimed to describe the characteristics of the respiratory physiotherapeutic treatment in a patient with nemaline myopathy. Here, we describe a case of a 43-yearold woman with nemaline myopathy undergoing pulmonary rehabilitation during short hospital admission for an acute exacerbation. At the time of hospitalisation, the patient was already under oxygen therapy (1 L/min) and noninvasive home ventilation using bi-level positive airway pressure with a nasal interface. Supplementary therapeutic exercises were implemented in addition to daily nasal noninvasive ventilation. At discharge, ultrasound examination revealed increased diaphragm trophism if compared with data obtained at hospital admission.

Prone versus supine position for regional cerebral tissue oxygenation in preterm neonates receiving noninvasive ventilation

Objective The prone position was found to improve oxygenation and pulmonary functions in neonates receiving respiratory support. However, how this improvement changes brain tissue oxygenation has not been studied. We aimed to investigate how prone position effects regional cerebral oxygen saturation (rScO2) and cerebral fractional oxygen extraction (FOE) in preterm neonates during noninvasive ventilation (NIV). Methods Preterm neonates < 37 weeks gestational age (GA) stable on NIV were enrolled. NIV was defined as nasal continues positive airway pressure or intermittent positive pressure ventilation via binasal prongs. Near infrared spectroscopy was used to measure rScO2. Monitoring was started when the infant was lying supine for at least 1 h and continued at the same body position at least for 1 h. Later the infant was changed to prone position and monitored for additional 3 h. Arterial oxygen saturation (SO2) was also continuously monitored and FOE was calculated from rScO2 and SO2. Results Mean GA and birth weight of the cohort (n = 32) were 30.63 ± 3.09 weeks and 1459 ± 581 g, respectively. There were 14 females and 18 males. Both SO2 (95 ± 2.2% versus 96.2 ± 1.9%, p = .001) and rScO2 (79.2 ± 3.4% versus 82.1 ± 3.2%, p < .001) were higher in prone position compared to supine position. Cerebral FOE (16.6 ± 0.8% versus 14.7 ± 0.8%, p < .001) and respiratory rate (57.3 ± 5.5 versus 55.6 ± 9.2, p = .003) were lower in prone position. Conclusion In preterm newborns, receiving nasal NIV for mild to moderate respiratory distress, arterial and cerebral oxygenations were better in prone position.

Comparison of Nasal Non-invasive Ventilation Methods in Preterm Neonates with Respiratory Distress Syndrome

Background: Humidified heated high flow nasal cannula (HHHFNC), nasal continuous positive airway pressure (NCPAP), and nasal intermittent positive pressure ventilation (NIPPV) are three nasal non-invasive ventilation methods. The purpose of this study was to compare these three methods in decreasing intubation and mechanical ventilation rate in preterm neonates with respiratory distress syndrome (RDS). Methods: This study was a randomized controlled study conducted on 160 neonates. The inclusion criteria for intubation in this study were persistent respiratory acidosis (arterial pH 60), hypoxemia, severe and repeated apnea episodes which did not respond to increasing respiratory rate and therefore required ventilation. Cranial Ultrasound was performed on the third day after birth. The data of all neonates were collected until the day of discharge and analyzed by SPSS (version 20) and statistical methods. Results: Based on the results,there was no significant difference among the three randomized methods. Out of all the cases, 72% of the neonates with NIPPV had successful non-invasive ventilation (35/53), compared to 73/6% in NCPAP (39/53) and 72/2% in HHHFNC (P=0/999). Similarly, there was no significant difference among the three methods in total ventilation time and the need for supplemental oxygen. Conclusion: The use of HHHFNC at birth in preterm neonates with RDS is safer than the other two methods. However, it is not more effective than the other two methods in the reduction of intubation rate.

Black Eschar on a 4-day-old Preterm Infant

A 4-day-old female neonate presented with a black necrotic lesion with circumferential ulceration and erythema located to the left of the umbilicus. ### Prenatal and Birth Histories ### Presentation The infant was admitted to the NICU. An umbilical venous catheter (UVC) was inserted with the use of betadine as the antimicrobial skin preparation and a thin hydrocolloid dressing (DuoDERM®, ConvaTec, Bridgewater, NJ) as a protective skin barrier to secure the UVC. The hydrocolloid dressing was located just left of the umbilicus and placed on intact abdominal skin. The infant was noted to have asymptomatic thrombocytopenia (platelet count 73,000/μL [73×109/L]) and neutropenia (absolute neutrophil count 700/μL [0.70×109/L]), which were attributed to maternal preeclampsia. The infant received 1 dose of granulocyte colony-stimulating factor (G-CSF, 10 μg/kg, subcutaneously) at 2 days of age. Prophylactic antibiotics were not indicated at the time of birth because there were no concerns for infection. The infant underwent extubation to receive nasal noninvasive ventilation within 24 hours of birth. …

Abstract P-463: MEDICAL DEVICE-RELATED PRESSURE ULCER PREVENTION BUNDLE IN A PAEDIATRIC UNIT: EVIDENCE-BASED QUALITY IMPROVEMENT PROJECT

Aims & Objectives: Medical device-related pressure ulcer (MDRPU) is one of the most preventable injuries worldwide yet becoming increasingly prevalent. This evidence-based quality improvement (EBQI) project aims to achieve 50% reduction in reported MDRPU within a paediatric intensive care unit (PICU) in a Singapore tertiary hospital. Methods An EBQI project utilising pre and post-implementation of MDRPU prevention bundle audit strategy. PICU patients were selected by consecutive sampling if they used oro-nasal or nasal non-invasive ventilation mask for minimum 24 hours continuously. Education sessions on the MDRPU prevention bundle were conducted by the PICU evidence-based nursing (EBN) champions from January to August 2017 (Figure 1). Visual aids (Figure 2) were placed in strategic locations in PICU. Thin foam dressings were used for patients under 5 years old and thicker foam dressing above 5 years old. Incidences of reported MDRPU were compared between 2016 and 2017. Clinical observation audit data on the nurses’ application technique, material selection and documentation of skin assessment and interventions were collected.Results Incidences of reported MDRPU decreased from 5% in 2016 to 1.96% in 2017, showing a relative risk reduction of 60.7%. Clinical observation audit data collection is ongoing and expected to be completed by March 2018. To date, nurses have selected appropriate materials and displayed proper application technique. Conclusions The MDRPU bundle was effective in reducing incidences of reported MDRPU by more than 50%. The project was successful as the PICU EBN champions introduced the MDRPU bundle, conducted education sessions and managed to close the gaps of nurses’ knowledge and practices related to MDRPU.

Use of Nasal Non-Invasive Ventilation with a RAM Cannula in the Outpatient Home Setting

Background:Nasal non-invasive-ventilation (Nasal NIV) is a mode of ventilatory support providing positive pressure to patients via a nasal interface. The RAM Cannula is an oxygen delivery device that can be used as an alternative approach to deliver positive pressure. Together they have been successfully used to provide respiratory support in neonatal in-patient settings.Objective:To describe the outpatient use of Nasal NIV/RAM Cannula as a feasible alternative for home respiratory support in children with chronic respiratory failure.Methods:We performed a retrospective case series of 18 children (4 months to 19 years old) using the Nasal NIV/RAM Cannula in the Pediatric Pulmonary Clinic at the McGovern Medical School, UTHealth (2014-16). Consideration for Nasal NIV/RAM Cannula utilization included: inability to wean-off in-patient respiratory support, comfort for dyspnea, intolerability of conventional mask interfaces and tracheostomy avoidance.Results:Average age was 7 years. 50% were Caucasian, 38% African-American and 11% Hispanics. Pulmonary disorders included: chest wall weakness (38%), central control abnormalities (33%), obstructive lung disease (16%) and restrictive lung disease (11%). Indications for Nasal NIV/RAM Cannula initiation included: CPAP/BPAP masks intolerability (11%), dyspnea secondary to chest wall weakness (38%) and tracheostomy avoidance (50%). Average length of use of Nasal NIV/RAM Cannula was 8.4 months. Successful implementation of Nasal NIV/Ram Cannula was 94%. One patient required a tracheostomy following the use of Nasal NIV/RAM Cannula. Significant decrease in arterial PaCO2 pre and post Nasal NIV/RAM cannula initiation was notable (p=0.001).Conclusion:Outpatient use of Nasal NIV/RAM Cannula may prove to be a feasible and save treatment alternative for children with chronic respiratory failure, chest wall weakness, dyspnea and traditional nasal/face mask intolerance to avoid tracheostomy.

A risk stratifying tool to facilitate safe late-stage percutaneous endoscopic gastrostomy in ALS

Background: The safety of percutaneous endoscopic gastrostomy (PEG) insertion in amyotrophic lateral sclerosis (ALS) patients with significant respiratory compromise has been questioned. Objectives: To review the characteristics of an ALS clinic patient cohort undergoing PEG, and the introduction of a risk stratification tool with procedural adaptations for higher-risk individuals. Methods: Patients undergoing PEG insertion were analysed (n = 107). Cases stratified as higher-risk underwent insertion in a semi-recumbent position, minimising sedation, with the option of nasal non-invasive ventilation. Results: All underwent successful PEG. One-third had pre-procedure FVC ≤50% (mean, 64 ± 22%). Of those who underwent PEG insertion after introduction of risk stratification (n = 58), 39 (67%) met criteria for being higher risk, 16 (41%) of whom had FVC ≤50% (p = 0.005). High-risk patients received lower sedative doses vs. the low-risk group (midazolam 2.1 ± 1.1 vs.2.8 ± 0.95mg, p = 0.021; fentanyl 42 ± 16 vs. 60 ± 21μg, p = 0.015). Four deaths occurred within one month of insertion (attributable to the natural disease course). Conclusions: Risk stratification identified a greater number of patients with evidence of respiratory compromise than using the sole criterion of FVC ≤50%. A modified PEG procedure enabled safe insertion despite respiratory compromise, in those who might not have tolerated attempted insertion by alternative means such as radiologically-inserted gastrostomy.

Evaluation of a Novel Highly Portable Nasal Noninvasive Ventilator in Patients With Chronic Respiratory Disease During Constant Work Rate (CWR) Exercise

Evaluation of a Novel Highly Portable Nasal Noninvasive Ventilator in Patients With Chronic Respiratory Disease During Constant Work Rate (CWR) Exercise

Non-invasive neurally adjusted ventilatory assist in preterm infants: a randomised phase II crossover trial

ObjectiveTo compare non-invasive ventilation neurally adjusted ventilatory assist (NIV-NAVA) and non-invasive pressure support (NIV-PS) in preterm infants on patient–ventilator synchrony.DesignA randomised phase II crossover trial.SettingNeonatal intensive care units of two...

Upper Airway Obstruction during Noninvasive Ventilation Induced by the Use of an Oronasal Mask

In patients with neuromuscular disorders, no randomized studies have been performed whether nasal or oronasal masks should be preferred. Oronasal masks are often used in acute respiratory failure, while nasal masks are preferred in patients with chronic respiratory failure. However, the use of nasal masks can result in mouth leaks with implications on sleep quality. To reduce these leaks, oronasal masks have been applied during home noninvasive ventilation (NIV). Until now, upper airway obstruction during NIV has been thought to be induced by nasal obstruction, pharyngeal collapse, and/or glottis closure. We report a case indicating another cause of upper airway obstruction: use of an oronasal mask can induce obstructive events in the upper airways, possibly resulting in sleep fragmentation and decreased efficiency of NIV.

Nasal Noninvasive Ventilation and Pneumothorax in the Pediatric Population

Nasal Noninvasive Ventilation and Pneumothorax in the Pediatric Population

Regression of sinus node dysfunction after treatment of obstructive sleep apnea

Background: Sleep apnea-hypopnea syndrome (SAHS) is characterized by repetitive upper airway obstruction or narrowing during sleep, resulting in cyclic fluctuations in sympathovagal balance, surges in blood pressure, repetitive hypoxemia or CO2 retention, and cardiac hemodynamic changes.1The prevalence of SAHS in the general adult population is around 3%, more common in men and with increasing age. Various cardiac arrhythmias are known to be associated with SAHS, among which the one with sick sinus syndrome is well recognized.2 We present a patient in whom SAHS treatment with noninvasive nasal ventilation (continuous positive airway pressure-CPAP) completely reversed sinus node dysfunction. So far, in cases where sinus node dysfunction (SND) is found together with clinical characteristics of a SAHS, management of sleep apnea would be prudent before deciding for a pacemaker. Case report description: A 28-year-old man presented with heavy snoring; his bed partner reports that he sometimes stops breathing while he sleeps. He admits to feeling sleepy at times when he drives, although he has not had any motor vehicle accidents. He has hypertension that is controlled by medication but is otherwise healthy. Physical examination reveals that he is overweight (body-mass index 33,8) and has a large neck circumference (49 cm). Holter monitoring showed a SND, with an average heart rate of 76 bpm (range, 23-141 bpm), an occasional run of self-limiting atrial tachycardia, and pauses of up to 3.2 s in the daytime and 7.63 s at night. The nocturnal polysomnography (PSG) revealed severe obstructive sleep apnea (apnea-hypopnea index, AHI, 64,2 minimum SpO2-76%). The primary decision to implant a pacemaker was altered in favor of treatment with nCPAP (nasal continuous positive airway pressure) following a careful and thorough evaluation of the patient's history and symptoms, after which a severe mixed SAHS was diagnosed. Conclusions: On diagnosing SAHS with an obstructive component in patients with symptomatic bradycardia and SA block, there is no primary need for a pacemaker, but rather for implementing treatment with nCPAP. Thus, a pacemaker should only be considered in patients with intolerance or bad compliance regarding nCPAP, or in those in whom no significant reduction of bradyarrhythmia is achieved.

Central venous cutdown in neonates: Feasibility as a bedside procedure without general anesthesia

Background/PurposeA silicone central venous catheter (CVC) is usually inserted using a percutaneous technique under general anesthesia. However, there are numerous reports on the postoperative adverse effects of general anesthesia in neonates. The aim of this study is to investigate the feasibility of open surgical cutdown (OSC) for central venous access without general anesthesia. MethodsThe medical records of patients who underwent OSC at bedside under sedation and local anesthesia were reviewed. Chloral hydrate (100mg/kg) was given orally for the induction of moderate to deep sedation 15minutes before OSC; then the operative field was infiltrated with 1% lidocaine. When adequate sedation was not achieved, a bolus of phenobarbital (20mg/kg) was given intravenously. ResultsThirteen Broviac lines were inserted into 12 patients. At insertion, the median gestational age was 29weeks, birth weight was 1,140g and age was 33days. No patients required invasive ventilator care; 7 patients received nasal non-invasive ventilator care. Neither intubation nor inotropics were required during the intra- or postoperative period and no perioperative surgical complications occurred. The median catheter duration was 19.5days. ConclusionOSC at bedside for CVC insertion, using adequate sedation and local anesthesia, is a feasible procedure in neonates.