Abstract:

Background: The aim of this retrospective analysis was to evaluate the clinical feasibility of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in infantsweighing less than 1500g.

Methods: The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using an in-plane approach the brachiocephalic vein was cannulated by usinga 24 gauge intravenous cannula under real-time ultrasound guidance into the vein followed by the insertion of a 2 French singlelumen catheter using the Seldinger technique.

Results: Forty-six brachiocephalic vein cannulations in infants weighing between 0.55 and 1.5kg (Median: 1.2; 95%-CI: 0.9-1.2) were included. Ultimate success rate was 89.1% (41 out of 46). One cannulation attempt was required in 30 (65.2%) patients, 2 in 6 (13%) and 3 in 5 (10.8%), respectively. Smaller weight babies did not require significantly more cannulation attempts (p=0.16). The probability of successful cannulation on the first attempt increased significantly from 40% (2010) to more than 80% (2019) (p=0.035) over the time course of this series. Median catheter dwell time was 15 days (95%-CI: 9-20) with one catheter being removed prematurely after 8 days due to obstruction.

Conclusion: Supracalvicular in-plane real-time ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and feasible option to provide large-bore central venous access for very small and sick babies.

Reference:

Breschan, C., Graf, G., Arneitz, C., Stettner, H., Feigl, G., Neuwersch, S., Stadik, C., Koestenberger, M., Holasek, S., and Likar, R. (2020) Feasibility of the ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in very small weight infants: A case series. Paediatric Anaesthesia. May 25th. https://doi.org/10.1111/pan.13928. (epub ahead of print).