A Systematic Ultrasound Evaluation of the Diameter of Deep Veins in the Newborn: Results and Implications for Clinical Practice

Abstract

Background: In adults and children, current guidelines recommend measuring the diameter of the vein before the insertion of central catheters, in order to match vein diameter with catheter caliber and thus reduce the risk of venous thrombosis. In the neonatal intensive care unit, central catheters are often used but the vein diameter is usually not considered. Method: We assessed the diameter of the most relevant deep veins in 100 newborns, using a strict protocol of ultrasound evaluation. Results: Mean gestational age of studied infants was 32 weeks and mean weight was 1,690 g. The mean diameter of the brachiocephalic vein was consistently ≥3 mm, with no significant difference between the right and the left side. The femoral vein diameter, on the other hand, was considerably smaller than 3 mm for infants with a weight < 2,000 g. Interobserver repeatability was found to be very high. Conclusion: Preprocedural ultrasound scan of veins is feasible and easy, also in newborns, and it should be recommended for optimizing central venous catheterization.

Ultrasound‐guided anatomical evaluation of right internal jugular vein in children aged 0‐2 years: A prospective observational study

“…In a study by Breshan et al, 14 the AP diameter and CSA of the RIJV were assessed in 60 infants with body weights of 1.4‐4.5 kg, and the correlations were reported to be positive with body weight and postconceptual age in this patient group. The AP diameters in this study were smaller than ours, which may be due to the smaller patients in the study by Breshan et al 14 In a similar study by Barone et al 4 addressing vein diameters in infants weighing <3000 g, the results for the AP diameter of the RIJV in patients weighing 2500‐3000 g were similar to our results for patients with similar body weights. However, we did not have smaller patients with weights <2100 g to make further comparisons.…”

“…Among the available cannulation techniques, the ultrasound (US)‐guided technique followed by the Rapid Central Vein Assessment (RaCeVA) protocol is the recommended technique for central venous access irrespective of the vein that is chosen 3 . With respect to the choice of the vein to cannulate, recent studies have recommended the left brachiocephalic vein (BCV) especially for infants, including preterm neonates with low‐birthweights, due its convenient anatomical structure and larger diameters than the other central veins 4,5 . However, despite its safety and reliability, US‐guided supraclavicular in‐plane (long‐axis [LAX] view) BCV access is a technique that requires specific training and experience 5 .…”

Aplicabilidade do ultrassom portátil para acessos venosos centrais em neonatos críticos: revisão de escopo

“…Apesar de não serem primeiras escolhas de acesso vascular, a instalação de CVC por técnica cirúrgica é habitualmente utilizada em UTIN e exige habilidade de cirurgiões pediátricos (Barone, D'Andrea, Vento, & Pittiruti, 2019;Ates, Derme, Yılmaz, Özkan-Ulu, & Canpolat, 2018;Montes-Tápia et al, 2016).…”

“…A implantação com imagem diminuiria complicações, tais como: hematoma, lesão nervosa, punção arterial inadvertida, pneumotórax, hemotórax e morte. A redução em até 60% da ocorrência destas complicações sustenta a recomendação da substituição da técnica de referência anatômica pela canulação guiada (Barone et al, 2019;Ates et al, 2018).…”

(Gefäß-)Anatomie im Neugeborenen-, Säuglings- und Kleinkindesalter

“…[17]. Überdies ist das Lumen, insbesondere der V. brachiocephalica, im Verhältnis relativ groß [18]. Diese Eigenschaften lassen die ultraschallgestützte Punktion der V. subclacia im Notfall als relativ günstig erscheinen [19].…”