Observational studyEuropean journal of pediatrics2026
Feasibility and procedural outcomes of ultrasound-guided brachiocephalic vein cannulation in neonates weighing less than 1,000 g: a prospective study.
Observational study in European journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the anatomical feasibility and procedural outcomes of ultrasound-guided right brachiocephalic vein cannulation for placing non-tunnelled centrally inserted central catheters in neonates weighing less than 1,000 g.
methodsThis single-center, prospective observational study assessed right BCV diameter using high-frequency ultrasound (Phase 1), defining anatomical feasibility as a diameter ≥ 2.0 mm (suitable for a 2 French catheter). Subsequently, ultrasound-guided cannulation was evaluated using a standardized "micro-access" bundle (Phase 2), measuring technical success, first-pass rate, and immediate complications.
resultsSixty neonates were enrolled (median weight, 865 g [interquartile interval, 620 to 970 g]). Anatomical feasibility was 100% (60/60); median diameter was 2.8 mm (interquartile interval, 2.6 to 3.0 mm). Right brachiocephalic vein diameter was significantly smaller in neonates weighing less than 750 g (n = 22) than in those weighing 750 to 1,000 g (n = 38) (median, 2.6 mm [interquartile interval, 2.4 to 2.7 mm] versus 2.95 mm [interquartile interval, 2.8 to 3.1 mm]; p < 0.001). Fifty-two catheterization procedures were performed in 47 infants. Technical success was 100% (52/52), with a first-pass success rate of 76.9% (40/52). No statistically significant difference in first-pass success was detected between the two weight groups (77.3% [17/22] in < 750 g versus 76.7% [23/30] in ≥ 750 g; p = 1.00). No immediate complications were observed (0/52).
conclusionUltrasound-guided right brachiocephalic vein cannulation is anatomically feasible and safe in neonates weighing less than 1,000 g, providing a reproducible central venous access pathway when performed with a standardized micro-access protocol. WHAT IS KNOWN: • Centrally inserted central catheters offer superior performance compared to peripherally inserted central catheters in infants, although clinical data regarding their placement in micro-preterm neonates remain limited. WHAT IS NEW: • The right brachiocephalic vein caliber consistently exceeds 2.0 mm in neonates weighing < 1,000 g, and a standardized "micro-access" bundle yields high technical success without immediate mechanical complications.
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