title: Ultrasound-guided supraclavicular cannulation of the right brachiocephalic vein in small infants: a consecutive, prospective case series.
abstract: BACKGROUND
  The supraclavicular ultrasound (US)-guided cannulation of the brachiocephalic vein (BCV) is one option of central venous line placement in infants.
  
  
  OBJECTIVE
  The aim of this prospective study was to evaluate whether there was an association between the optimum ultrasonographic view as obtained of the entire longitudinal extension of the right BCV and the ease of supraclavicular cannulation when using a strict in-plane technique via a linear US probe in small infants.
  
  
  METHODS
  The US probe was placed in the right supraclavicular region. If the optimum obtainable sonographic view presented the entire longitudinal extension of the right BCV demonstrating clearly its path caudally alongside the pleura, it was graded as I. If, however, only a circular view, i.e., the initial part of the right BCV was obtainable via US, it was graded as II. The right BCV was cannulated by advancing a 22-gauge i.v. cannula from lateral to medial strictly under the long axis of the US probe under direct US vision into the vein.
  
  
  RESULTS
  Seventy-nine infants weighing between 0.8 and 4.5 kg (Median: 3.4 ± 0.09) were included. In 50 (63.3%) patients, the sonographic view was graded as I and in 29 (36.7%) as II. The proportion of patients successfully cannulated on the first attempt was significantly smaller in patients graded as II, i.e., circular, sonographic view of the right BCV than in patients graded as I, i.e., sonographic view of the entire longitudinal extension of the right BCV (41% vs 90%; chi-square analysis: P < 0.01).
  
  
  CONCLUSIONS
  The sonographic view obtainable of the entire longitudinal extension of the right BCV resulted in significantly fewer required cannulation attempts.
authors.affiliation: Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Breschan
authors.affiliation: Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Graf
authors.affiliation: Department of Anesthesia, Krankenhaus Spittal/Drau, Spittal/Drau, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Jost
authors.affiliation: Department of Statistics, University of Klagenfurt, Klagenfurt, Austria.
authors.forename: Haro
authors.initials: H
authors.lastname: Stettner
authors.affiliation: Department of Anatomy, Medical University of Graz, Graz, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Feigl
authors.affiliation: Department of Pediatric Surgery, Klinikum Klagenfurt, Klagenfurt, Austria.
authors.forename: Alja
authors.initials: A
authors.lastname: Goessler
authors.affiliation: Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Neuwersch
authors.affiliation: Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Koestenberger
authors.affiliation: Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Likar
mesh_terms: D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging*; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: brachiocephalic; infant; subclavian; ultrasound; vein