Central venous access in neonates: Comparison of ultrasound-guided percutaneous access and minimal surgical open methods

Abstract

Background: In neonates, percutaneous central venous catheter (CVC) insertion is often a challenging technique. Recent reports have reported the efficacy of ultrasound (US) guidance when performing such an intervention. We conducted this study to compare US-guided and minimal surgical CVC insertion regarding time and ease of insertion, reliability, and complications. Patients and Methods: This prospective randomized study included 92 neonates scheduled for CVC insertion. They were divided into two groups: Group A (46 neonates) underwent the US-guided approach and Group B (46 neonates) underwent the surgical approach. The number of attempts and the duration of the procedure were documented in both groups. In addition, intraoperative and postoperative complications were recorded. Results: Each of patient's age, gender, weight, and the indication of catheter insertion were statistically comparable between the two groups. The number of trials showed a significant increase in Group A (1.52 vs. 1.07 in Group Bp <0.001). Nevertheless, the time of the procedure was significantly decreased in the same group (3.68 vs. 10.21 in Group Bp <0.001). Table 2 summarizes the previous findings. Failure was encountered only in one case in Group A (2.2%), which was converted to the open surgical technique. In general, the incidence of complications showed no significant difference between the two approaches. Conclusion: Although US-guided CVC insertion is associated with an increased number of trials, the duration of the procedure is significantly diminished with its use. Furthermore, it has a high success rate in addition to a comparable complication profile with the traditional surgical method.