Bedside Ultrasound-Guided Innominate Vein Cannulation for Central Line Placement in Newborns

Despite not being the first choice, central venous access is often the most suitable option for critically ill infants in the Neonatal Intensive Care Unit (NICU). This study reports our initial experience with bedside ultrasound-guided innominate vein central venous access in infants weighing less than 4.5 kg, performed by an attending surgeon's vascular team.

A retrospective analysis was conducted using a prospective database of patients who underwent bedside ultrasound-guided innominate vein central venous catheter (CVC) insertion via a supraclavicular approach in the NICU from October 2020 to March 2023 (29 months). Data recorded at the time of insertion and prospectively uploaded to a RedCap® database included birth data, age, weight at the time of insertion, clinical indication, and perioperative and postoperative complications (within 30 days).

Seventy-five consecutive nontunneled catheters were placed in 57 patients weighing less than 4.5 kg. Assisted by a neonatologist, all procedures were performed bedside in the NICU under tracheal intubation, analgesia, and muscle relaxation. Ultrasound guidance was used in all procedures. The right innominate vein was accessed in 23 cases, and the left innominate vein in 52 cases. Catheter insertion was achieved in fewer than three attempts in 72 cases: fifty infants were cannulated in one attempt, 19 in two attempts, and 3 in three attempts. There were no perioperative or postoperative complications. Central line-associated bloodstream infection (CLABSI) rate was 3.98 catheter- 1000 days.

Based on this initial experience, we conclude that ultrasound-guided innominate vein cannulation is feasible and safe for infants under 4.5 kg.

Level IV (Case series with no comparison groups).