Ultrasound-guided cannulation of the brachiocephalic vein in neonates: Feasibility and safety

Central venous catheter placement (CVC) in the neonatal population poses significant challenges, particularly for critically ill neonates with low birth weight and younger gestational age. Several devices and techniques can be used to place a CVC, each with its own advantages and disadvantages. Ultrasound (US) guided central inserted central catheter (CICC) of the brachiocephalic vein (BCV) is a new approach that may be advantageous in case of difficult central venous access.

To evaluate the feasibility and outcomes of the supraclavicular US guided cannulation of the BCV in newborns.

Case series including all neonates in whom US-guided supraclavicular cannulation of the BCV was performed.

This is a prospective, single-center study conducted in the neonatal intensive care unit in Sousse, Tunisia, between January 1, 2021, and December 31, 2023.

Inclusion criteria were all neonates whose medical situation required ultrasound guided CICC placement of BCV. Exclusion criteria were thrombosis of the homolateral or contralateral brachiocephalic vein, skin infection or malformations at the homolateral brachiocephalic vein puncture site.

The study included 62 patients with a mean gestational age of 38.42 ± 2.2 weeks (34-42), mean weight of 3400 g ± 580 g (2500-4800 g). The procedure achieved a 96.7% success rate, with 80.4% of catheters successfully placed on the first attempt. The mean insertion depth of the catheter insertion was 6.4 cm ± 0.5 cm (5-7). Immediate complications were absent in 96% of cases, and catheters were accurately positioned in 80% of patients. The median catheters dwell time was 11.5 ± 8 days (1-42). Late complications included thrombosis 4.8% and CRBSI rate of 3.9 per 1000 catheter days.

The real-time, in-plane, US-guided supraclavicular approach for BCV cannulation is a feasible and safe alternative for CVC in neonates.