Ultrasound-guided central line insertion and standard peripherally inserted catheter placement in preterm infants: Comparing results from prospective study in a single-center

Abstract

Background:Among preterm infants, the peripherally inserted central catheter (PICC) is the standard line for central venous access; however, its placement exposes them to hypothermia and pain. Ultrasound (US)-guided central line insertion may be less morbid than standard PICC line.Aims:To determine the ease, success rate, and morbidity associated with US-guided central line insertion in the internal jugular vein (IJV) by comparing it to the standard PICC line placement.Materials and Methods:This is a single-center nonrandomized prospective study evaluating preterm infants between October 2013 and June 2014. Patients were allocated into two groups: The standard group (control group) who underwent blind PICC line insertion and the intervention group who underwent a percutaneous US-guided central line insertion in the IJV. The epicutaneo-cava-catheter was used in both groups.Results:Fifty neonates were enrolled on study. A statistically difference in favor of US-IJV insertion was noted concerning the rate of successful first attempt (P < 0.001), insertion (P = 0.001), and procedure duration (P < 0.001) and number of trials (P < 0.001) compared to PICC. No difference in complications (P = 1.000) was noted.Conclusion:US guided catheterization of the IJV technique is faster than PICC line insertion with higher rates of successful first attempt and insertion, less procedure duration and fewer number of trials compared to PICC line insertion. There were no differences in complications.

Transcatheter Closure of Patent Ductus Arteriosus in Premature Infants With Very Low Birth Weight

“…However, according to our data, the femoral vein in a 509-g baby had a diameter of 1.3 mm ( Figure 1B ) and could tolerate the 4F femoral sheath during the procedure without complications. Al Hamod et al ( 33 ) suggested the echo-guided puncture method in preterm babies; we adopted this method for our procedures from case 18 onward to facilitate the intervention. The umbilical vein approach is another alternative to neonatal cardiac catheterization ( 34 ).…”

Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line–associated bloodstream infection in preterm infants

“…Nonetheless, ECCs do not permit the blood sampling, hemodynamic monitoring, multiple simultaneous infusions, or high-flow infusion rates that may be needed in critically ill preterm infants. Additionally, insertion failure rates are relatively high, and progression to a central position is hazardous even in experienced hands [40]. Catheter dysfunction and mechanical complications such as thrombosis and infiltration are relatively frequent, which often leads to nonelective removal [41].…”

Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Neonates and Preterm Infants: A Prospective Observational Study

“…Its main disadvantages are hazardous venous progression after initial insertion with significant failure rates even in exert hands, the risk of noncentral position that can be associated to infiltration, infection, thrombosis or cardiac tamponade, and a small caliber with high resistance to flow that precludes blood sampling and rapid infusion. 26,27 Severely ill neonates such as those receiving high-risk surgery (e.g., complicated necrotizing enterocolitis) may be better candidates for a large bore percutaneously inserted CVCs. However, there are currently no prospective studies in neonates comparing PICC with CVC, so the decision of either catheter will depend on the patient's characteristics and the professional's preference.…”