title: Brachiocephalic vein for percutaneous ultrasound-guided central line positioning in children: A 20-month preliminary experience with 109 procedures.
abstract: Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20-month experience with this approach in children.
  
  
  
  All patients who underwent percutaneous USG central venous catheter (CVC) positioning in the BCV between August 2013 and March 2015 have been included. Devices inserted during this period were open-ended, either single or double-lumen tunneled CVC. Our series was divided into three consecutive study periods in order to determine the relative incidence of repositioning and complications.
  
  
  
  During the study period, a total of 95 patients underwent 109 CVC insertions in the BCV. The median length of CVC duration was 230 days for a total of 23,212 catheter days. No major intraoperative complications occurred. Overall rate of CVC-related postoperative complications requiring repositioning or precocious removal was 0.90 per 1,000 catheter days and involved 21 CVC (19%, 95% confidence interval 13-28). These included 18 dislodgments, two infections, and one malfunction. Double-lumen CVCs represented the only significant risk factor for complications (52% complications-three per 1,000 catheter days).
  
  
  
  USG supraclavicular cannulation of the BCV represents a safe approach for central line placement in children. It proved to be versatile, as it can be used in premature infants as well as in adolescents. Provided it is adopted by operators experienced in USG cannulation, we strongly suggest to resort to this approach as a first-line choice in children undergoing tunnelled central line placement for long-lasting therapy.
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Stefano
authors: S
authors: Avanzini
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Leila
authors: L
authors: Mameli
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Nicola
authors: N
authors: Disma
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Clelia
authors: C
authors: Zanaboni
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Andrea
authors: A
authors: Dato
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Giovanni
authors: G
authors: Montobbio
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Luigi
authors: L
authors: Montagnini
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Michela
authors: M
authors: Bevilacqua
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Filomena
authors: F
authors: Pierri
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Massimo
authors: M
authors: Conte
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Loredana
authors: L
authors: Amoroso
authors: Giannina Gaslini Institute, Genoa, Italy.|University of Genoa, Genoa, Italy.
authors: Giovanna
authors: G
authors: Pala
authors: University of Genoa, Genoa, Italy.
authors: Sara
authors: S
authors: Pestarino
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Elio
authors: E
authors: Castagnola
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Angelo Claudio
authors: AC
authors: Molinari
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Concetta
authors: C
authors: Micalizzi
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: Giuseppe
authors: G
authors: Morreale
authors: Giannina Gaslini Institute, Genoa, Italy.|DINOGMI, University of Genoa, Genoa, Italy.
authors: Girolamo
authors: G
authors: Mattioli
authors: Giannina Gaslini Institute, Genoa, Italy.
authors: A
authors: A
authors: Pini Prato
mesh_terms: D000293:Adolescent; D000328:Adult; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging*; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
keywords: CVC; brachiocephalic vein; chemotherapy; total parenteral nutrition; ultrasound