The Role of Bedside Ultrasonography in Neonatal Central Venous Access Applications

Vascular access in critically ill neonates is crucial for management and is often challenging. Neonatal venous access must allow for the administration of all necessary medications and diagnostic tests. For these purposes, the catheter must be centrally located. Therefore, determining the correct location of the tip of central venous access devices is crucial, and traditionally, this assessment has relied on thoracoabdominal radiography. However, this method has limitations; it is an indirect method that uses radiological landmarks, is postprocedural, can only be used for tip location, and has long-term risks because of ionizing radiation. Current guidelines recommend that the imaging method used in central venous access procedures be real-time, intraprocedural, rapid, accurate, easy to use, noninvasive, reproducible, and inexpensive. Bedside ultrasonography, which possesses all these features, is considered the ideal imaging method. Ultrasonography is used with various catheter types for selecting the appropriate vein for catheterization, during needle insertion, for advancing the catheter in the correct direction, for catheter tip navigation, for determining catheter tip position, for monitoring puncture-site-related complications, and for identifying and monitoring late complications. The goal of this review was to examine the advantages and feasibility of using bedside ultrasonography in central venous catheter insertion procedures, especially in the newborn period.