A Retrospective Analysis of the Clinical Effectiveness of Supraclavicular, Ultrasound-guided Brachiocephalic Vein Cannulations in Preterm Infants

Abstract

Background The aim of this retrospective analysis was to evaluate the clinical effectiveness of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in preterm infants. Methods The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using a strict in-plane approach the brachiocephalic vein was cannulated by advancing a 22- or 24-gauge iv cannula from lateral to medial under the long axis of the ultrasound probe under real-time ultrasound guidance into the vein. Results One hundred and forty-two cannulations in infants weighing between 0.59 and 2.5 kg (median: 2.1; CI: 2.0 to 2.2) were included. Ultimate success rate was 94% (134 of 142). One cannulation attempt was required in 100 (70%) patients, two attempts in 21 (15%), and three attempts in 13 (9%). The smaller the weight of the infant the more attempts were needed. More attempts also were needed for the right brachiocephalic vein, which was primarily targeted in 75 (53%) neonates. One (1%) inadvertent arterial puncture was noted. Conclusions This supraclavicular, in-plane, real-time, ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and effective method to insert central venous catheters in preterm infants.

Ultrasound‐guided totally implantable venous access device through the right innominate vein in older patients is safe and reliable

“…Statistically, the cannulation success of the left INV clearly proved to be superior to the right INV for infants and neonates. 20,22 However, in adults, the left INV is in a deeper location and has a larger variation than the right INV; this is poorly shown by US. In addition, US is unable to identify the thoracic duct if it is merged through the left INV junction.…”

“…With the introduction of US into routine clinical practice, the INV approach has regained interest because of the superficial location of INV and lack of bone overlying the vein, thus making it possible to visualize the entire path of the needle during cannulation. In recent years, some studies have described US‐guided cannulation of INV, which represents a safe and reliable approach …”

“…In recent years, some studies have described US-guided cannulation of INV, which represents a safe and reliable approach. 7,[20][21][22][23] Beccaria et al retrospectively compared US-guided central line insertions through the INV and IJV sites in terms of procedural difficulties, first pass failure rate, overall failure rate and safety. 7 The success rate of the first attempt in INV sites was 90.18% (257/285), and in the IJV approach, it was 85.18% (611/709).…”

Ultrasound‐guided supraclavicular brachiocephalic vein access complicated with a kinked guidewire in a neonate

“…To the Editor, In-plane ultrasound-guided supraclavicular brachiocephalic vein access is recommended as an effective and safe approach in infants including preterm neonates. 1,2 The aim of this report was to highlight the importance of visualizing the needle tip inside the vein prior to and during advancement of the guidewire.…”

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

“…39,40 Real-time US is the modality of choice for venous access guidance. [41][42][43] Preferred sites of access include the deep veins of the neck and chest (eg, internal jugular or brachiocephalic veins) or the deep veins of the arm and shoulder (brachial, proximal basilic, and axillary), [44][45][46] although patient-specific factors may affect selection. Other conventional routes, including femoral, 47 subclavian, and cephalic veins, are associated with higher rates of mechanical and infectious complications.…”