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Supraclavicular Access Guided By Ultrasound In Newborn Under 1000 Grs. Experience Of 10 Patients In Neonatal Critical Care Unit.

Pablo Bravo, Ricardo Carvajal, Carolina Mendez

LEARNING OBJECTIVE

Retrospective review of newborns under 1000 g; who are trying to install central venous catheter (Arrow 22 or 24 Gauge) with US between October 3, 2010 and December 30, 2018.

Describe our experience in the installation of the central venous catheter guided by ultrasound in newborns under 1000 gr

INTRODUCTION

Placing central catheters in children, especially in small infants, is more difficult than in adult patients.

The use of the US has improved the success rate and reduction of complications.

Placement of a central venous catheter (CVC) in the brachiocephalic vein (BCV) via the ultrasound (US)-guided supraclavicular approach was recently described in children, this access is very useful in vein very small, especially in newborn.

RESULTS

In the period studied, the first 10 patients under 1000 grams in who central supraclavicular access was attempted were described.

From 10 patients in 8 it was possible to puncture the vein. Average weight 684 grams; female gender 6/10, the use catheter: frequent blood samples and antibiotics, the punctured side was right 6 / 10.

Failure rate after 3 attempts 20%. The highest success rate was at 2 attempts.

There was no mechanical complication or respiratory deterioration secondary to pneumothorax or hemothorax. All attempts were in Invasive Mechanical Ventilation, highlighted 1 in High Frequency Ventilation.

All received sedation with midazolam and Fentanyl.

There were no thrombotic complications in these patients.

COMMENTS AND CONCLUSIONS

The access of the BCV is safe in less than 1000 grams, in personnel with experience, it represents a failure in 2 patients both with intent in right side, described in the literature much more difficult for its greater angulation.

The central route guided by ultrasound is an alternative in this group of patients that require the use of antibiotics when they do not have peripherally inserted central catheter or it can´t be used due to incompatibility of drugs or the use of vasoactive drugs.

Also in the case frequent blood samples allows better gasometric and metabolic monitoring avoiding painful punctures.

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