Central venous silicone elastomer catheter placement by basilic vein cutdown in neonates

There is a need for central venous access in small premature infants and other neonates when enteral feeding is not tolerated or is contraindicated. We placed 83 small (0.635-mm od) silicone elastomer catheters by basilic vein cutdown through a subcutaneous tunnel in 79 patients during a 12-month period. Thirty-five patients (44%) weighed less than 1,000 g. Each patient on whom the procedure was attempted had successful placement of a catheter, and they remained in place a mean of 20 days (range three to 82). Patients had a mean weight gain of 15 g per day of catheter use. Sixty-two catheters (75%) were removed electively, 13 (16%) secondary to complications, six (7%) because of patient deaths (none catheter related), and two (2%) were accidentally dislodged. Two episodes of catheter-related sepsis (0.12 episodes per 100 days of catheter use) caused by Candida albicans and Staphylococcus epidermidis were encountered. Other complications included one subclavian vein thrombosis, eight catheter occlusions, and two local arm inflammations. This technique proved to be a safe, easy, and inexpensive method to administer parenteral nutrition to neonates, especially those weighing less than 1,000 g.