Percutaneous and surgical placement of fine silicone elastomer central catheters in high-risk newborns

Percutaneous insertion of fine silicone elastomer catheters (0.6 millimeters outside diameter) have been used for central parenteral nutrition of very low birth weight and other high risk infants. Because peripheral venous access can be limited in the newborn, we report the previously undescribed surgical cannulation of the superficial arm veins with this catheter, and compare our experience with this technique and the percutaneous method in neonates. A central catheter position was attained in 88% of surgical (38 of 43) and 74% of percutaneous (17 of 23) cannulations. The two groups did not differ in birth weight or gestational age. The mean duration of catheterization was similar in the two groups (combined means = 21.8 +/- 2.3 days SEM). There was no difference in weight gain (combined means = 16.9 +/- 1.0 grams SEM per day) or head growth (combined means = 1.1 +/- 0.1 millimeters per day) between the groups and these rates approximated known fetal growth rates for our mean gestational age. Disseminated candidiasis, in a 770-gram infant with thymic hypoplasia, caused the only systemic infection and death among our 49 patients. The most commonly encountered problem was catheter occlusion secondary to a blood clot at the tip of these fine catheters (8 of 55). No thromboembolic events were recognized, and minor complications were not different with the two techniques. Surgical cannulation of the superficial arm veins offers a safe alternative to percutaneous central silicone elastomer catheter placement if superficial venous access is not available. Both methods provided early, adequate parenteral nutrition without excessive fluid intake in our high-risk infants, and undoubtedly contributed to a favorable neonatal outcome.