Surgical insertion of central venous catheters in low-birth-weight neonates

Abstract

Aim: Neonatal central vascular access (CVA) represents a daily practice in  neonatal intensive care unit. Low birth weight (LBW) neonates pose a challenge to anesthetists who try the landmark technique to cannulate central veins. We reported our experience of open surgical cutdown (OSC) to insert catheters through right internal jugular vein (IJV) and assessed feasibility, operative time, durability of line, and postoperative complications of this technique.
Methods: A total of 660 LBW neonates needed CVA and underwent OSC of right IJV because of medical and surgical indications. We reported operative time, whether anesthesia or sedation, whether in the theater or at the bedside, difficulties,  complications and duration of line, and causes of failure. Transverse neck incision was made 1 cm above the medial third of the clavicle, right IJV was identified,  venotomy was performed, and catheter was inserted.
Results: A total of 660 LBW neonates had CVA in right IJV, ligation of vein occurred in the first 30 cases but later venotomy was repaired. Mean operative time was 11.3 min. No injury of the right carotid artery or vagus was reported. None had postoperative pneumothorax. Overall, 542 cases had lines until they were  discharged. A total of 43 cases needed redo. Thirty-five cases had line-associated infection and 40 lines were thrombosed.
Conclusion: OSC of right IJV was feasible and had lower complication rates.

Keywords: neonate, surgery, vascular access