Ultrasound-guided subclavian vein cannulation in infants and children: a novel approach

Background. Central venous cannulation in infants remains challenging even for experienced paediatric anaesthesiologists. Ultrasound (US)-guidance techniques are proven to be safer for internal jugular vein catheterization. But the subclavian vein (SCV) is often the preferred site for long-term central venous catheterization in children. We describe a novel US-guided approach for SCV cannulation in infants and children. 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 via the usual infraclavi-cular route to cannulate it under ultrasonic control. Details and pitfalls of this technique are described. The prospectively collected results of our first 25 punctures are reported. Results. Patients ’ weight and age range were 2.2–27 kg and 1 day to 9 yr, respectively: 76 % of the children weighed less than 10 kg. The success rate at the first attempt was 84 % and 100 % after two attempts. An asymptomatic thrombus in the SCV could also be detected with this technique. Conclusions. This US-guided approach of the SCV offers a new possibility for central venous catheterization in children. This technique seems promising for children less than 10 kg and prob-ably also for older children. It provides good quality needle guidance and allows to check the vessel patency before puncture