title: [Ultrasound-guided cannulation of the brachiocephalic vein in neonates and infants].
abstract: BACKGROUND
  Central 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.
  
  
  METHODS
  Case 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.
  
  
  RESULTS
  The 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 CVCs were withdrawn after 9 (6-15) days.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España; IBIOMED, Instituto de Biomedicina de León. Electronic address: Ignacio.oulego@gmail.com.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Oulego-Erroz
authors.affiliation: Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España; IBIOMED, Instituto de Biomedicina de León.
authors.forename: Paula
authors.initials: P
authors.lastname: Alonso-Quintela
authors.affiliation: Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España.
authors.forename: Patricia
authors.initials: P
authors.lastname: Domínguez
authors.affiliation: Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rodríguez-Blanco
authors.affiliation: Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España.
authors.forename: Manoel
authors.initials: M
authors.lastname: Muñíz-Fontán
authors.affiliation: Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Muñoz-Lozón
authors.affiliation: Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España.
authors.forename: Gloria
authors.initials: G
authors.lastname: López-Blanco
authors.affiliation: Servicio de Críticos y Urgencias Pediátricas, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Nuñez
mesh_terms: D016121:Brachiocephalic Veins; D002405:Catheterization, Central Venous / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018084:Ultrasonography, Interventional
keywords: Brachiocephalic vein; Canalización venosa central; Central venous catheterization; Ecografía; Infant; Lactante; Neonate; Neonato; Tronco braquiocefálico; Ultrasound