Ultrasound-guided percutaneous insertion of 2.7 Fr tunnelled Broviac lines in neonates and small infants

Insertion of permanent central venous access (Broviac line) can be a challenge in neonates especially when sites for peripherally inserted central catheters (PICC) have been exhausted. The landmark technique (LT) has been well described for the percutaneous insertion of central lines in neonates but can be associated with significant complications including death. The use of the ultrasound-guided approach for temporary central line access has been reported but as yet there are no reports of the adaptation of the technique for Broviac line insertion in neonates. A prospective database records all procedures carried out by the vascular access team and any complications which occur; this database was reviewed from November 2004 to January 2008. A consecutive series of 34 neonates underwent insertion of 36 Broviac lines using the ultrasound-guided percutaneous technique with a 2.7 Fr silastic line and a 3 Fr peel-apart sheath. Median gestational age was 34 weeks (range 24-40), chronological age was 102 days (14-209 days), weight 2.9 kg (0.63-4.1). Successful cannulation occurred in 100% of patients. There were no cases of arterial puncture or perioperative complications due to surgery. The ultrasound-guided percutaneous approach for insertion of tunnelled permanent vascular access is safe in neonates with no surgical complications in our series. However, it is a technically demanding procedure to do in neonates and should not be attempted without significant prior experience.