Topographical anatomy of central venous system in extremely low‐birth weight neonates less than 1000 grams and the effect of central venous catheter placement

Abstract

Central venous catheterization is widely used in neonatology. Although ultrasonic guidance for central venous catheter placement is available, complications occur significantly more frequently in infants, especially neonates, than in adults. This study seeks to determine the characteristics, topographical conditions, regional relationships, and diameters of the venous structures of the upper extremity and the thoracic central venous system in extremely small preterm neonates (mean: 900 g). Nine formaldehyde-fixed preterm stillborns were prepared (mean 27 2/7 weeks' gestational age). The anatomical preparation involved the complete thoracic wall, neck and shoulder region, and preparation of the upper extremities. It was shown that the course of the internal jugular vein can be influenced by rotation of the head. Maximum head rotation (80°) to the contralateral side leads the internal jugular vein to overlap the common carotid artery and sharpens the confluence angle of the internal jugular into the brachiocephalic vein. We propose that this has the potential to result in dislocation of the catheter. Less rotation of the head (<30°) is favorable as the internal jugular vein and common carotid artery run in parallel. Commonly used central venous catheters (2F-4F) may not occlude the vascular lumen completely. Small central venous cannulation using a single-orifice catheter through arm veins (1F) may also not occlude peripheral vessels of the upper extremity (cephalic and basilic veins). The right internal jugular vein has a straight course, appears suitable for central venous access and less hazardous, especially when using stiff catheters. The use of small straight wire guides is recommended.

Ultrasound‐guided supraclavicular cannulation of the brachiocephalic vein in infants: a retrospective analysis of a case series

“…This necessitates excellent hand–eye coordination, which may be more difficult for the right BCV because of the slightly more caudally orientated US probe placement. In addition, the left BCV is apparently larger than the right one in preterm babies (13).…”

Vascular assessment of the right internal jugular vein in low birth weight newborns

“…In a pathological study of neonates less than 1000 g, Eifinger et al [8] reported RIJV diameters of 4.1 AE 0.8 mm. These dimensions are greater than in our population.…”

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

“…As a consequence, the needle advancement in the in-plane technique is believed to be more difficult on the right side. This may be of greater importance in smaller patient, especially as the left BCV is apparently larger that the right in preterm babies (32). Yet, no clear recommendation as to which side, if any, is first choice can be given based on the current published literature.…”