• Ignacio Oulego-Erroz, Paula Alonso-Quintela, Patricia Domínguez, Silvia Rodríguez-Blanco, Manoel Muñíz-Fontán, Ana Muñoz-Lozón, Gloria López-Blanco, and Antonio Rodríguez-Nuñez.
• Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España; IBIOMED, Instituto de Biomedicina de León. Electronic address: Ignacio.oulego@gmail.com.
• An Pediatr (Barc). 2016 Jun 1; 84 (6): 331-6.

IntroductionCentral venous catheter (CVC) insertion in neonates and small infants is a challenging and high risk procedure. Ultrasound (US) guided cannulation increases the success rate and reduces procedural-related complications. The internal jugular vein is the most frequent site for US-guided CVC insertion. However this approach is technically demanding in neonates and small infants. US-guided supraclavicular cannulation of the brachiocephalic vein (BCV) is a new approach that may be advantageous in case of difficult central venous catheterization. We present our preliminary experience with this technique in a case series of neonates and small infants.MethodsCase series of neonates and small infants weighing less than 5kg, in whom US-guided supraclavicular cannulation of the BCV was attempted. A longitudinal "in plane" supraclavicular approach to the BCV was performed using a 12Hz linear or a 8Hz microconvex transducer. All cannulations were performed by the same operator, a pediatrician with previous experience in US-guided central venous catheterization.ResultsThe study included 6 patients with a median (range) weight of 2.1 (0.94-4.1) kg and age of 1.9 (0.6-4) months. Two cases required 2 punctures, while cannulation was achieved at the first attempt in the remaining 4 cases. There were no procedural or catheter-related complications. CVCs were withdrawn after 9 (6-15) days.ConclusionsThe US-guided supraclavicular approach to the BCV is a feasible and safe alternative in neonates and very small infants. More studies are needed to define the role of this new venous access before its routine application in daily practice.Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

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