Supraclavicular Approach to Ultrasound-Guided Brachiocephalic Vein Cannulation in Children and Neonates

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.

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

“…The standard preprocedural evaluation was performed by using the US-scanning technique, first identifying the left internal jugular vein (LIJV), then moving the probe caudally, and keeping the vein in view until it was confluent with the subclavian vein to locate the BCV. 1,2 The anterior-posterior and transverse diameters and depth from skin in short-axis view for LIJV were 4.6, 6.9, and 3.9 mm, respectively. The diameter for LBCV was 4.7 mm in long-axis view (LAX) ( Figure 1A).…”

“…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.…”

“…Learner-centered, constructivist education (such as a "flipped classroom") has been shown to be superior to a traditional lecture format, 1 with a Cohen's d of 2 in one study. 2 While traditional lecture formats are necessary and useful, the logistical realities of staffing anesthesia patient care at academic medical centers often preclude the protected availability of all residents, CRNAs, fellows, SRNAs, and attending anesthesiologists at a without a syringe attached. 1,2 In our practice, we prefer using the needle with a 2-mL syringe attached to gently aspirate the blood to verify intravascular placement because the low venous pressure in neonates may prevent the spontaneous return of blood.…”

“…2 While traditional lecture formats are necessary and useful, the logistical realities of staffing anesthesia patient care at academic medical centers often preclude the protected availability of all residents, CRNAs, fellows, SRNAs, and attending anesthesiologists at a without a syringe attached. 1,2 In our practice, we prefer using the needle with a 2-mL syringe attached to gently aspirate the blood to verify intravascular placement because the low venous pressure in neonates may prevent the spontaneous return of blood. 2 After ensuring that the needle tip is in the vein, the nondominant hand holding the US probe puts the probe away to hold the needle in place to enable the dominant hand advance the guidewire.…”

“…1,2 In our practice, we prefer using the needle with a 2-mL syringe attached to gently aspirate the blood to verify intravascular placement because the low venous pressure in neonates may prevent the spontaneous return of blood. 2 After ensuring that the needle tip is in the vein, the nondominant hand holding the US probe puts the probe away to hold the needle in place to enable the dominant hand advance the guidewire. Hence, it is not always possible to see the guidewire advancement; therefore, it is crucial not to exert any force in case of resistance.…”