Vascular access in the neonate

Keywords: neonate vascular access ultrasound complications Up to recently, inserting venous or arterial 'lines' in the neonate was essentially based on clinical skill and experience. The recent advent of portable ultrasound (US) machines with paediatric probes has resulted in the development of new approaches that, if correctly learned and used, should allow quicker and safer vascular access in this population. Both classic and new techniques are reviewed on the basis of literature and authors' experience. Live illustrations are freely available at www. Ó 2010 Elsevier Ltd. All rights reserved. Obtaining vascular access in the neonate is a challenging and important aspect of their care. Some of the challenges are unique to the neonatal population. New equipment such as ultrasound (US) and newer types of catheter, such as peripherally inserted central catheters (PICCs), have produced substantial changes and opportunities, and increasingly the choice of access and management of the lines is becoming evidence based. Ultrasound for vascular access in the neonate The use of US has greatly increased the efficiency of gaining intravenous access in the neonate. The advantages are greatest when using the correct equipment. In the neonate, the structures are small and room for the US probe is limited; the equipment should include Doppler (screening for occlusion and thrombosis) and zoom functions, and a high-frequency (>10 MHz) 'small' (<30 mm width) linear US probe. Sterile gel and probe covers should be used for US guidance (Video 1). US visualisation of vessels can be don