Safety and Feasibility of Ultrasound-Guided Brachiocephalic Venipuncture for Centrally Inserted Central Catheters in Newborns: A Multicenter Observational Study.
Abstract
Background
Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein (BCV) is a promising approach for neonatal central venous access, but multicenter data on feasibility, safety, and reproducibility remain limited. RESEARCH QUESTION In critically ill neonates requiring centrally inserted central catheters (CICCs), is ultrasound-guided supraclavicular BCV access feasible across centers and associated with low procedural and catheter-related complication rates? STUDY
Design
AND
Methods
We conducted a retrospective multicenter observational study in three level III NICUs in Italy, including 361 BCV venipunctures for CICC placement from January 2022 to December 2025. We collected demographic, procedural, and outcome data from electronic and paper records. Primary outcomes were immediate procedural complications, venipuncture attempts, first-attempt success, and catheter dwell time; secondary outcomes included catheter-related bloodstream infection (CRBSI), mechanical complications, and secondary malposition. Analyses were descriptive.
Results
Median weight at insertion was 2500 g and median age was 16 days; median catheter dwell time was 20 days, yielding 10,575 catheter-days of follow-up. All 361 CICCs were successfully placed. First-attempt success occurred in 325 procedures (90.0%), and the mean number of venipuncture attempts was 1.1 per patient. No immediate major complications occurred, including arterial puncture, pneumothorax, or hemothorax. CRBSI occurred in 18 catheters (4.9%; 1.7 per 1000 catheter-days), mechanical complications in 15 (4.1%), and secondary malposition in 10 (2.7%).
Interpretation
Ultrasound-guided supraclavicular BCV catheterization was feasible, reproducible, and associated with low immediate complication rates across three NICUs. These findings support this technique as an effective option for neonatal central venous access when performed within a standardized ultrasound-guided protocol.