Subclavian vein catheterization for central line placement in children under 2 years of age

Using subclavian vein catheterization after unsuccessful internal jugular venous puncture, the authors have been successful in 23 of 32 children younger than 2 years of age. There was no mortality, and minimal morbidity, with this procedure. Cannulation should be performed in most cases on the first insertion of the needle, and the Seldinger technique using a J-wire aids in catheter placement. Though we did not cause pneumothorax, the inability to obtain a chest x ray prior to the operative procedure in most patients causes us to suggest that this technique be used only on those patients requiring an open chest operative procedure.