Ultrasound-guided subclavian vein cannulation in infants: supraclavicular approach.

BACKGROUND: Ultrasound (US) guidance techniques are reported to be safe for internal jugular vein catheterization, although anatomic conditions are not favorable for this approach in infants. The subclavian vein (SCV) seems to be a better site for long-term central venous catheterization in children, with a supraclavicular approach to avoid compression of the central venous catheter between the clavicle and the first rib ('pinch-off' syndrome). We describe a new US-guided approach for supraclavicular SCV cannulation in infants.

METHODS: The principle of this technique is to place the US probe at the supraclavicular level to obtain a longitudinal view of the SCV, and to gain access to the vein with a total ultrasonic control (in-plane puncture) via a supraclavicular approach known since 1965, but rarely used in blind puncture. The results of 37 US-guided SCV cannulations in infants weighing <10 kg are reported.

RESULTS: Forty-two infants were enrolled in this observational study, and five infants with bad visualization of SCV were excluded. The procedure duration was <5 min in all cases except one. The success rate at the first attempt was 81% and 100% after two attempts. No major complications were reported.

CONCLUSIONS: This US-guided supraclavicular approach for SCV puncture is a new possibility for central venous catheterization in small infants, offering all the advantages of SCV cannulation without the risk of 'pinch-off' syndrome. This technique seems valuable for children and infants and quite easy to apply for physicians trained to US guidance punctures.