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Ultrasound-Guided Subclavian Vein Cannulation in Low Birth Weight Neonates

Lausten-Thomsen, Ulrik MD, PhD1; Merchaoui, Zied MD1; Dubois, Cécile MD1,2; Eleni Dit Trolli, Sergio MD1,3; Le Saché, Nolwenn MD1; Mokhtari, Mostafa MD1,4; Tissières, Pierre MD, PhD1–3

Pediatric Critical Care Medicine: February 2017 - Volume 18 - Issue 2 - p 172-175
doi: 10.1097/PCC.0000000000001028
Neonatal Intensive Care
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Objectives: Central venous access in critically ill, small infants remains technically challenging even in experienced hands. Several vascular accesses exist, but the subclavian vein is often preferred for central venous catheter insertion in infants where abdominal malformation and/or closure of the vein preclude the use of umbilical venous catheters, as catheterization of the subclavian vein is easier in very short necks than the internal jugular vein for age-related anatomical reasons. The subclavian vein approach is yet relatively undescribed in low birth weight infants (i.e., < 2,500 g), and this study aims to explore the feasibility of this technique in very small infants.

Design: Retrospective data collection of prospectively registered data on central venous catheter insertion in infants.

Setting: Neonatal ICU and PICU at a university hospital.

Patients: One hundred and five newborn children hospitalized in at the ICU.

Interventions: An ultrasound-guided supraclavicular approach was applied on all infants who had an subclavian vein catheterization during a 30-month period from January 2013 to July 2015.

Measurements and Main Results: One hundred seven supraclavicular subclavian vein catheters were placed in 105 children weighing less than 5,000 g. Among those, 40 patients weighed less than 2,500 g and 10 patients weighed less than 1,500 g. Successful central venous catheter insertion, defined as the correct placement of a functional double-lumen catheter (3F or 4F), was obtained in 97.3%. All three registered failed attempts were due to hematomas from venous bleeding and occurred in infants weighing greater than 2,500 g. No case of accidental arterial puncture or pleural puncture was registered.

Conclusions: This large series of subclavian vein catheterizations in small infants demonstrates the feasibility of subclavian vein catheterizations even in very small neonates weighing less than 1,500 g.

1Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, Paris, France.

2School of Medicine, Paris South University, Le Kremlin-Bicêtre, Paris, France.

3Institute of Integrative Biology of the Cell—UMR 9198, Paris Saclay University, Gif-sur-Yvette, Paris, France.

4Espace Ethique/IDF, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.

Dr. Trolli received support for article research: National Institutes of Health (NIH), Wellcome Trust/COAF, Howard Hughes Medical Institute (HHMI), Austrian Science Fund (FWF), Bill & Melinda Gates Foundation, World Bank, Research Councils UK (RCUK), and other. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Centre Hospitalier Universitaire de Bicêtre, Pole Femme-Mère-Enfants-Adolescents, Réanimation Pédiatrique et Néonatale, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre. E-mail: ult@dadlnet.dk; ulrik.lausten-thomsen@aphp.fr

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies