Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line–associated bloodstream infection in preterm infants

Abstract

The objective of this study was to assess the risk of central line-associated bloodstream infection (CLABSI) of ultrasound (US)guided cannulation of the brachiocephalic vein (BCV) compared to standard epicutaneous cava catheters (ECCs) in preterm infants. This was a retrospective cohort study in preterm infants with a birth weight of less than 1500 g. Each BCV catheter was matched 1:3 with ECCs according to sex, birth weight, and year of insertion. The main outcome was the CLABSI density rate per 1000 days. Secondary outcomes included CLABSI episodes, CLABSI episodes per infant, and CLABSI/death. A multivariate Cox regression analysis was performed to assess whether the type of catheter (ECC vs. BCV) was associated with CLABSI risk. Ninety-six catheters (21 BCVs and 75 ECCs) in 79 infants were included (993 catheter days). BCV catheters were associated with a reduced CLABSI density rate compared to ECCs (3.05/1000 days vs 21.1/1000 days; p < 0.001). ECCs were associated with increased CLABSI risk compared to BCV catheters in multivariate analysis (hazard ratio 36; (95% CI, 2.5-511); p = 0.008).Conclusion: US-guided supraclavicular cannulation of the BCV was associated with a reduced risk of CLABSI compared to ECCs. This finding deserves further multicenter research. What is Known:• An epicutaneous-cava catheter (ECC) is commonly used in preterm infants for routine care (eg. delivery of nutrition and antibiotics) but this device may not suffice in infants who need high-intensity care (multiple drugs, hemodynamic monitoring, fluid resuscitation etc.). • Ultrasound-guided brachiocephalic vein (BCV) catheterization has shown a high success rate and few immediate complications in neonates and small infants but it has never been compared to standard ECCs. What is New: • When the operator in properly trained, US guided cannulation of the BCV in preterm infants is feasible, safe and may reduce the risk of CLABSI compared to standard ECCs. • This fact may expand the use of BCV catheters in selected high-risk preterm infants who need a large bore venous access.

Practice Patterns of Central Venous Catheter Placement and Confirmation in Pediatric Critical Care

“…9 While not commonly reported among our respondents, US can be used for subclavian access and has been demonstrated in adults to reduce complications. 12 Multiple small, singlecentered studies in pediatrics demonstrated high success rate reaching 100%, [13][14][15] with shorter procedure duration, 15 lower CLABSI rate, 16 and low to no major complications such as arterial puncture or pneumothorax. 11,15,17,18 Nonetheless, US use for subclavian placement is not routine for adult patients 19,20 and the pediatric data presented here are also consistent with that practice.…”

Ultrasound‐guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut

“…On the other hand, the lumen size and blood flow of BCV are the largest among those available central veins, including IJV and SCV, 18 and the catheter-to-vein diameter ratio of the catheter (Babyport, 4.5F = 1.49 mm) and BCV (about 3.2 mm-diameter in infants) 9 is less than 45%, which has been considered as a protective factor for CRT. Moreover, the cannulation site of the catheter is located in the supraclavicular fossa, 17 which may alleviate patient discomfort at the neck, 7 reduce the risk for infection, 12,18 and maintain a smoother catheter curvature. 21 To our knowledge, no previous literature has evaluated using BCV approach for TIVAP placement in pediatric oncology population.…”

“…The IJV approach has disadvantages of higher puncture point, smaller catheter radian, risk of misplacement, catheter bending and blockage, and patient discomfort due to longer catheter trajectory 7 ; whereas the landmark SCV access is prone to be kinking such as pinch-off syndrome, and has a relatively lower success rate at first attempt and a higher intraoperative conversion rate to a secondary site. 8 However, since the initial report of ultrasound-guided brachiocephalic vein (BCV) approach in the supraclavicular region by Breschan et al 9 in 2011, it has been widely used in adults, 10 children, [11][12][13] infants, 14,15 and even premature infants [16][17][18] for central venous catheters' (CVCs) insertion procedure.…”

Co-administration of drugs with parenteral nutrition in the neonatal intensive care unit—physical compatibility between three components

“…Due to their small size and narrow veins, most preterm neonates only tolerate the insertion of a single or double lumen central venous catheter (CVC) or peripherally inserted central catheter (PICC). Even though, the vascular access technology and culture has evolved, and jugular and brachiocephalic short and large catheters can be inserted under ultrasound guidance [ 1 – 3 ]. Limited venous access is a considerable challenge for the involved health care professionals when they have to administer several drugs, PN and blood transfusions intravenously and often together via the same catheter lumen [ 4 ].…”