title: Ultrasound-Guided Percutaneous Central Venous Access in Low Birth Weight Infants: Feasibility in the Smallest of Patients.
abstract: OBJECTIVE
  The insertion of tunneled central venous access catheters (CVCs) in infants can be challenging. The use of the ultrasound-guided (UG) approach to CVC placement has been reported in adults and children, but the technique is not well studied in infants.
  
  
  METHODS
  A retrospective review was performed of infants under 3.5 kg who underwent attempted UG CVC placement between August 2012 and November 2013. All infants underwent UG CVC placement using a standard 4.2-French or 3.0-French CVC system (Bard Access Systems, Inc., Salt Lake City, UT). The UG approach was performed on all infants with the M-Turbo(®) ultrasound system (SonoSite, Inc., Bothell, WA). The prepackaged 0.025-inch-diameter J wire within the set was used in all infants weighing greater than 2.5 kg. A 0.018-inch-diameter angled glidewire (Radiofocus(®) GLIDEWIRE(®); Boston Scientific Inc., Natick, MA) was used in infants less than 2.5 kg. Data collected included infant weight, vascular access site, diameter of cannulated vein (in mm), and complications.
  
  
  RESULTS
  Twenty infants underwent 21 UG CVC placements (mean weight, 2.4 kg; range, 1.4-3.4 kg). Vascular CVC placement occurred at the following access sites: 16 infants underwent 17 placements via the right internal jugular vein, versus 3 infants via the left internal jugular vein. The average size of the target vessel was 4.0 mm (range, 3.5-5.0 mm). One infant had inadvertent removal of the UG CVC in the right internal jugular vein on postoperative Day 7. This infant returned to the operating room and underwent a successful UG CVC in the same right internal jugular vein. There were no other complications in the group.
  
  
  CONCLUSIONS
  The UG CVC approach is a safe and efficient approach to central venous access in infants as small as 1.4 kg. Our experience supports the use of a UG percutaneous technique as the initial approach in underweight infants who require central venous access.
authors.affiliation: 1 Division of Pediatric Surgery, Johns Hopkins Hospital , Baltimore, Maryland.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Goldstein
authors.affiliation: 1 Division of Pediatric Surgery, Johns Hopkins Hospital , Baltimore, Maryland.
authors.forename: Howard
authors.initials: H
authors.lastname: Pryor
authors.affiliation: 1 Division of Pediatric Surgery, Johns Hopkins Hospital , Baltimore, Maryland.
authors.forename: Jose H
authors.initials: JH
authors.lastname: Salazar
authors.affiliation: 2 Division of Pediatric Anesthesia, Johns Hopkins Hospital , Baltimore, Maryland.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Dalesio
authors.affiliation: 1 Division of Pediatric Surgery, Johns Hopkins Hospital , Baltimore, Maryland.
authors.forename: F Dylan
authors.initials: FD
authors.lastname: Stewart
authors.affiliation: 1 Division of Pediatric Surgery, Johns Hopkins Hospital , Baltimore, Maryland.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: 1 Division of Pediatric Surgery, Johns Hopkins Hospital , Baltimore, Maryland.
authors.forename: Paul
authors.initials: P
authors.lastname: Colombani
authors.affiliation: 1 Division of Pediatric Surgery, Johns Hopkins Hospital , Baltimore, Maryland.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Lukish
mesh_terms: D001835:Body Weight; D002405:Catheterization, Central Venous / Q000379:methods*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*