Centrally inserted central catheters in preterm neonates with weight below 1500 g by ultrasound-guided access to the brachio-cephalic vein

Barone, Giuseppe; Pittiruti, Mauro; Ancora, Gina; Vento, Giovanni; Tota, Francesca; D’Andrea, Vito

doi:10.1177/1129729820940174

Cited by 43 publications

(45 citation statements)

References 18 publications

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“…Recent publications describing ultrasound guided brachiocephalic vein cannulation in preterm infants and neonates offers a large caliber central vein option for the expert level operator. 5,6,34 A comparative prospective study between the ST-FICC and the Tunneled CICC in neonatal patient population is warranted to assess the advantages and risks of thoracic vein cannulation versus the femoral vein approach. Appropriateness for the ST-FICC is an individualized decision based on patient factors and availability of trained staff.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit

Ostroff¹,

Zauk

Chowdhury

et al. 2020

J Vasc Access

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Objective: The purpose of this retrospective analysis was to evaluate the clinical efficacy and safety of ultrasound (US)-guided, subcutaneously tunneled, femoral inserted central catheters (ST-FICCs) in the neonatal intensive care unit (NICU). Methods: Following clinical success with ST-FICCs in adults, we expanded this practice to the neonatal population. In an 18-month retrospective cohort analysis (2018–2020) of 82 neonates, we evaluated the clinical outcome for procedural success, completion of therapy, and incidence of early and late complications for insertion of US-guided ST-FICCs in the NICU. Results: Placement of ST-FICCs were successful in 100% of neonates ( n = 82/82) with 94% to the right ( n = 77/82) and 6% to the left common femoral veins ( n = 5/82). Gestational age ranged 23-39 weeks with median age of 29 weeks. Birthweight ranged from 450 g to >2000 g. Weight at insertion ranged 570 to 3345 g and day of life 1 to 137, with median at day 5. Ultrasound guided femoral vein puncture was recorded on 74 patients, first attempt 63/74 (85%), second attempt 8/74 (11%) and third attempt 3/74 (4%). Catheter french used: 1.9Fr ( n = 80/82), 2.6Fr ( n = 1/82), and 3-Fr ( n = 1/82). Catheter lengths were 8 to 20 cm, average 12cm. Catheter termination confirmed with posterior/anterior and lateral abdominal radiographs with inferior vena cava (IVC) ( n = 33/82), IVC/right atrial junction ( n = 31/82), or right atrium ( n = 18/82). Atrial placements were retracted; no cases of malposition to the lumbar/renal/hepatic veins ( n = 0/82). 1528 catheter days ranging 5 to 72 days (average 18). No insertion-related or post-insertion complications. All patients completed prescribed therapy with one catheter. Conclusion: Bedside placement of an ST-FICC is a safe route for central venous access in the NICU, preserving upper extremity vasculature, eliminates risks associated with sedation, fluoroscopy, tunneled and non-tunneled supra-diaphragmatic central venous insertion.

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Section: Discussionmentioning

confidence: 99%

A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit

Ostroff¹,

Zauk

Chowdhury

et al. 2020

J Vasc Access

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“…The internal jugular, subclavian, brachiocephalic, and femoral veins were the most used puncture sites for central venous catheterization for neonates. [13][14][15][16] In this study, we provided alternative ECC placement access sites for premature neonates with difficult ECC placement access through the distal superficial femoral and axillary veins. The distal superficial femoral vein was more suitable than the axillary vein for ECC placement in premature neonates with the ultrasound-guided MDNTP technique due to its higher success rate at the first attempt, lower number of trials, and shorter procedural duration.…”

Section: Discussionmentioning

confidence: 99%

“…The internal jugular, subclavian, brachiocephalic, and femoral veins were the most used puncture sites for central venous catheterization for neonates. 13–16 In this study, we provided alternative ECC placement access sites for premature neonates with difficult ECC placement access through the distal superficial femoral and axillary veins.…”

Section: Discussionmentioning

confidence: 99%

Distal superficial femoral vein versus axillary vein central catheter placement under ultrasound guidance for neonates with difficult access: A randomized clinical trial

Tan

Liu

et al. 2021

J Vasc Access

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Background: Epicutaneo-caval catheters (ECCs) are extensively used in premature and ill neonates. This prospective, randomized, observational study aimed to compare the outcomes of ECC placement in the distal superficial femoral and axillary veins in neonates with difficult ECC access. Methods: In a neonatal intensive care unit at a tertiary referral center, 60 neonates with difficult ECC access were randomized into two groups with catheters placed using the ultrasound-guided modified dynamic needle tip positioning (MDNTP) technique: distal superficial femoral vein (DSFV) and axillary vein (AV) groups. Results: The first attempt success rate was significantly higher in the DSFV group than in the AV group [23/30 (76.7%) vs 11/30 (36.7%), p = 0.001; odds ratio (OR), 0.176; 95% confidence interval (CI) 0.057–0.543]. The mean procedural duration was significantly shorter in the DSFV group than in the AV group [mean: 308.5 (standard deviation: 81.1) s vs 522.74 (134.8) s, t = −7.17, p < 0.001]. The incidence of complications was significantly lower in the DSFV group than in the AV group [4/30 (13.3%) vs 12/30 (40.0%), p = 0.019; OR, 4.333; 95% CI 1.203–15.604]. The number of attempts was significantly fewer in the DSFV group than in the AV group ( p = 0.012). Conclusions: The distal superficial femoral and axillary veins are two alternative and safe access points for ECC placement in premature neonates (weight < 2.5 kg) with difficult access. However, access through the distal superficial femoral vein was quicker, easier, and had fewer complications than through the axillary vein.

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“…No entanto, esses dispositivos muito pequenos não são adequados para altas vazões e, havendo necessidade de taxas de infusão mais altas, um cateter 2 French é mais adequado, porém, muito mais difícil de colocar se não for inserido pela técnica de Seldinger. 2 Por ser pouco provável ter um diâmetro compatível entre cateter/veia em prematuros extremos, poucos estudos em RNs com peso inferior a 1.500 gramas foram publicados. Análise retrospectiva avaliou a segurança e a viabilidade da técnica de Seldinger em RNs pré-termos abaixo de 1.500 gramas com média de idade gestacional de 26 semanas.…”

Section: Discussionunclassified

“…1 O cateter umbilical é considerado a primeira escolha em Neonatologia para a instalação de cateter venoso central (CVC), mas que também apresenta limitações, devendo ser substituído por outro tipo de CVC caso a terapia infusional ultrapasse sete dias. 2 A utilização de cateteres centrais de inserção periférica (PICC) é frequente em unidades de terapia intensiva neonatal (UTIN) em recém-nascidos (RNs) a termo e prematuros recebendo terapias venosas com drogas vesicantes e irritantes. 3 Além disso, dependendo do calibre, também são usados para exames de sangue, transfusão de hemoderivados e monitoramento hemodinâmico.…”

Section: Introductionunclassified

Recursos tecnológicos em neonatologia: evidências sobre a técnica de seldinger no cateterismo venoso central

Secco¹,

Pereira²,

Arrué³

et al. 2021

REME

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Objetivo: identificar as evidências científicas acerca da técnica de Seldinger na inserção de cateteres venosos centrais em Neonatologia. Método: revisão integrativa nas bases de dados SCOPUS, MEDLINE, Web of Science, Science Direct, Alliance For Vascular Access Teaching and Research e em citações de interesse. Realizada no mês de dezembro de 2020, sem delimitação temporal. Resultados: foram encontrados 804 artigos. Destes, 18 foram incluídos. As publicações compreenderam o período de 1982 a 2016. Predominaram estudos internacionais, com níveis de evidência pouco robustos, desenvolvidos por médicos anestesistas e cirurgiões. A técnica de Seldinger foi considerada um método assertivo que garante mínima incidência de complicações e oferece segurança ao paciente. Além disso, é menos estressante comparada à punção direta. Conclusão: é uma tecnologia que carece de ampliação do número de pesquisas clínicas para estabelecer fortes evidências e incorporação na assistência qualificada e segura aos recém-nascidos.

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Centrally inserted central catheters in preterm neonates with weight below 1500 g by ultrasound-guided access to the brachio-cephalic vein

Cited by 43 publications

References 18 publications

A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit

A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit

Distal superficial femoral vein versus axillary vein central catheter placement under ultrasound guidance for neonates with difficult access: A randomized clinical trial

Recursos tecnológicos em neonatologia: evidências sobre a técnica de seldinger no cateterismo venoso central

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