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Bedside Ultrasound-Guided Innominate Vein Cannulation for Central Line Placement in Newborns
Pablo D' Alessandro1, Ramiro Ortiz2, Camila Marossero2
1Department of Pediatric Surgery, Juan P. Garrahan National Pediatric Hospital, Buenos Aires Autonomous City, Argentina; Department of Pediatric Surgery, San Pedro de Alcántara Hospital, Cáceres, Extremadura, Spain.
Ultrasound-guided innominate vein cannulation is a safe and feasible central venous access method for critically ill infants under 4.5 kg in the Neonatal Intensive Care Unit (NICU). This technique demonstrated no perioperative complications and a low central line-associated bloodstream infection rate.
Area of Science:
- Neonatal Intensive Care Unit (NICU) procedures
- Vascular access in critically ill infants
- Ultrasound-guided interventions
Background:
- Central venous access is crucial for critically ill infants in the NICU.
- Innominate vein cannulation offers a viable central venous access option.
- Limited data exists on ultrasound-guided innominate vein access in low-birth-weight infants.
Purpose of the Study:
- To report the initial experience with bedside ultrasound-guided innominate vein central venous access.
- To evaluate the feasibility and safety of this technique in infants weighing less than 4.5 kg.
- To assess perioperative and postoperative complications and central line-associated bloodstream infection (CLABSI) rates.
Main Methods:
- Retrospective analysis of a prospective database (October 2020 - March 2023).
- Inclusion of 57 infants weighing < 4.5 kg undergoing ultrasound-guided innominate vein catheterization via supraclavicular approach.
- Data collection included patient demographics, indications, and complications within 30 days.
Main Results:
- 75 central venous catheters (CVCs) placed in 57 infants; 23 right innominate vein, 52 left innominate vein.
- Successful cannulation in < 3 attempts for 72 cases (50 in 1 attempt).
- No perioperative or postoperative complications; CLABSI rate of 3.98 per 1000 catheter-days.
Conclusions:
- Ultrasound-guided innominate vein cannulation is feasible and safe for infants < 4.5 kg.
- This technique can be performed bedside in the NICU with high success rates.
- The procedure is associated with minimal complications and a low CLABSI rate.
