Vascular Preservation for Long-term Central Venous Access in Infants: The Facial Vein as an Underutilized Option

Patients in the neonatal intensive care unit (NICU) may require long-term intravenous access for antibiotic administration, parenteral nutrition, resuscitation, and fluid support. In certain populations, particularly those with short bowel syndrome or with intestinal failure, preservation of vascular access is critical, as progressive loss of central venous access remains a major indication for intestinal transplantation and is associated with significant morbidity and mortality. The common facial vein has been sparsely described as an alternative route for central venous access and clinical data describing its outcomes and practical role remain limited. The primary aim of this study is to describe a single-center experience with tunneled facial vein catheter placement in neonates, focusing on feasibility, safety, and its role in emerging strategies directed towards vascular preservation. Data was obtained retrospectively from NICU patients who had a tunneled central venous catheter insertion between 2013 to 2019. A total of 72 upper body, tunneled central venous catheters were placed of which, 48 used the right or left facial vein as the access site, 13 were placed on the right or left internal jugular veins, and 11 of them were placed on the right or left subclavian vein. Evaluated outcomes included the incidence of intra/post operative hemorrhage, vagus nerve injury, cervical hematoma, palsy of mandibular branch of facial nerve, catheter blockage leading to re-operation, catheter infection, and operative time. Patients who had facial vein access were compared to the other upper body sites and the data was analyzed using a Pearson Chi-Squared test. There was no statistical significant difference regarding complications comparing facial vein access with the two aforementioned access sites. In addition, facial vein operative time was significantly shorter compared to internal jugular vein catheter placement. We propose tunneled facial vein catheterization represents a safe, practical, and underutilized option for neonatal central venous access. Its use may be exceptionally valuable in patients requiring long-term therapy in whom preservation of traditional access sites is essential.