Ultrasound-guided cannulation of the brachiocephalic vein in newborns: A novel approach with a supraclavicular view for tip navigation and tip location
Abstract:Purpose: Central vascular catheters (CVCs) are frequently used in newborns in NICU. Ultrasound (US) guided supraclavicular venipuncture of the brachiocephalic vein (BCV) is usually performed with a 12 MHz linear probe and then a catheter tip location is verified with an 8 MHz micro-convex probe or intracavitary ECG (IC-ECG). We explored the feasibility of an US guided puncture using a 7 MHz sector probe, positioned on the clavicular sternal joint. We also explored the opportunity of performing it with a probe … Show more
“…32 Ultrasound-guided venipuncture is feasible also in neonates, as shown in previous studies. 36,48,49 Ultrasound also allows to immediately exclude early pleuro-pulmonary complications (such as pneumothorax) and allows to verify the correct direction of the guidewire and/or of the catheter (tip navigation). 6 (4) Intracavitary ECG as a non-invasive intra-procedural method of tip location has been often used in pediatric and neonatal patients.…”
Background: In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. Methods: The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study. Results: All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded. Conclusion: The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.
“…32 Ultrasound-guided venipuncture is feasible also in neonates, as shown in previous studies. 36,48,49 Ultrasound also allows to immediately exclude early pleuro-pulmonary complications (such as pneumothorax) and allows to verify the correct direction of the guidewire and/or of the catheter (tip navigation). 6 (4) Intracavitary ECG as a non-invasive intra-procedural method of tip location has been often used in pediatric and neonatal patients.…”
Background: In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. Methods: The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study. Results: All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded. Conclusion: The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.
“…Complication rates range from 0% to 9%, with the rate of major complications such as arterial puncture or pneumothorax <1%. 5,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In the present study, the first attempt success rate of US-guided BCV catheterization was 94.6%, and the overall success rate was 100%, which was consistent with the findings in the available literature. No complications developed during the procedure in any case.…”
Background: Centrally inserted central catheters (CICCs) are commonly used to monitor venous pressure and administer parenteral nutrition and drugs in newborns. In the present study, we evaluated cannulation success rates, cannulation time, and frequency of complications in catheterization of the internal jugular vein (IJV) and brachiocephalic vein (BCV). Methods: The present study included patients who underwent IJV and BCV catheterization under ultrasound (US) guidance. The patients were divided into two groups, IJV and BCV, depending on the vein in which the CICC was utilized. We documented the diameters of the IJVs and BCVs, first attempt and overall success rates, mean cannulation time, and complication rates. Results: A total of 79 patients were evaluated, 37 in the BCV group and 42 in the IJV group. No significant differences were observed between the two groups in terms of sex, mean age, or weight range ( p > 0.05).The mean vein diameter was significantly larger in the BCV group than in the IJV group ( p < 0.001); the mean number of attempts was significantly higher in the IJV group than in the BCV group ( p < 0.001); the mean cannulation time was significantly longer in the IJV group than in the BCV group ( p < 0.001); and the first attempt success rate was 50% in the IJV group, versus 94.6% in the BCV group. The overall success rate was 100% in both groups. The rate of complications was 8.6% in the IJV group, while no complications developed in the BCV group. Conclusions: Given the larger diameter of the vessel, BCV catheterization was found to result in quicker cannulation and lower complication rates. The results of the present study suggest that BCV catheterization should be the first choice for neonatal intensive care unit (NICU) patients who require parenteral support or close venous pressure monitoring.
Vascular access in neonates and small infants is often challenging. Ultrasound (US) screening and guidance improves its safety and efficacy. The advantages of a pre-implantation ultrasound examination are intuitive; it is a practical and safe technique that doesn’t use radiation, allowing static and dynamic evaluations to be carried out and identifying anatomical variations, the caliber and depth of the vessel, the patency of the entire course and attached structures (nerves, etc.). Optimization of the image is a crucial aspect in achieving a clear view of all anatomical structures while avoiding complications. The goal of this review was to look into the benefits of using US in invasive catheter insertion procedures, especially in pediatric patients. Ultrasonography is used to visualize vessels and related structures in two dimensions (2D), sometimes with the help of color Doppler to detect the presence of intraluminal thrombi by applying gentle compression to assess vessel collapse and evaluate morphologic changes in the internal jugular vein (IJV) who had undergone central venous catheter (CVC) insertion during the neonatal period (Montes-Tapia et al. in J Pediatr Surg 51:1700–1703, 2016).
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