Brachiocephalic centrally inserted central catheters in infants born < 32 weeks gestation and/or < 1500 g: a...

Ultrasound-guided centrally inserted central catheters (CICCs) via the supraclavicular brachiocephalic vein have emerged as an alternative to epicutaneo-caval catheters (ECCs) and may offer practical advantages, including vasoactive drug administration, blood transfusion, and repeated blood sampling through a stable central venous access. We compared CICCs and ECCs regarding procedural feasibility and catheter-related outcomes in infants born < 32 weeks gestation and/or weighing < 1500 g. Sixty-six infants born before 32 weeks gestation and/or weighing < 1500 g who underwent CICC or ECC insertion according to predefined local practice were prospectively included, with one index catheter procedure analyzed per infant. Procedure-related adverse events occurring during or within 24 h after insertion were categorized as major mechanical complications or physiological adverse events. Secondary outcomes included procedural feasibility, catheter dwell time, and catheter-related complications. Sixty-six infants were analyzed (24 CICC and 42 ECC). Infants receiving CICCs were more premature, had lower birth weight, and more frequently required mechanical ventilation and vasoactive support. No major mechanical complication occurred in either group; physiological adverse events occurred in 2/24 (8.3%) CICC and 3/42 (7.1%) ECC procedures. CICCs remained in place significantly longer than ECCs. Confirmed central line-associated bloodstream infection occurred in 3/24 (12.5%) CICCs and 6/42 (14.3%) ECCs, while other catheter-related complications occurred in 2/24 (8.3%) and 2/42 (4.8%), respectively.

Despite preferential use in the most immature and critically ill infants, CICC placement was feasible and provided prolonged central venous access. CICCs may represent a complementary vascular option for selected preterm infants with complex intravenous therapy requirements.

• Epicutaneo-caval catheters (ECCs) are commonly used for prolonged central venous access in neonatal intensive care but may have limitations in critically ill preterm infants requiring complex intravenous therapies. • Evidence comparing ECCs and centrally inserted central catheters (CICCs) remains limited.

• CICCs were successfully used in the most immature and critically ill preterm infants. • CICCs provided prolonged central venous access in this prospective cohort, with few observed catheter-related complications.