Feasibility and procedural outcomes of ultrasound-guided brachiocephalic vein cannulation in neonates weighing less than 1,000 g: a prospective study.

PURPOSE: To evaluate the anatomical feasibility and procedural outcomes of ultrasound-guided right brachiocephalic vein cannulation for placing non-tunnelled centrally inserted central catheters in neonates weighing less than 1,000 g. METHODS: This single-center, prospective observational study assessed right BCV diameter using high-frequency ultrasound (Phase 1), defining anatomical feasibility as a diameter ≥ 2.0 mm (suitable for a 2 French catheter). Subsequently, ultrasound-guided cannulation was evaluated using a standardized "micro-access" bundle (Phase 2), measuring technical success, first-pass rate, and immediate complications. RESULTS: Sixty neonates were enrolled (median weight, 865 g [interquartile interval, 620 to 970 g]). Anatomical feasibility was 100% (60/60); median diameter was 2.8 mm (interquartile interval, 2.6 to 3.0 mm). Right brachiocephalic vein diameter was significantly smaller in neonates weighing less than 750 g (n = 22) than in those weighing 750 to 1,000 g (n = 38) (median, 2.6 mm [interquartile interval, 2.4 to 2.7 mm] versus 2.95 mm [interquartile interval, 2.8 to 3.1 mm]; p < 0.001). Fifty-two catheterization procedures were performed in 47 infants. Technical success was 100% (52/52), with a first-pass success rate of 76.9% (40/52). No statistically significant difference in first-pass success was detected between the two weight groups (77.3% [17/22] in < 750 g versus 76.7% [23/30] in ≥ 750 g; p = 1.00). No immediate complications were observed (0/52). CONCLUSION: Ultrasound-guided right brachiocephalic vein cannulation is anatomically feasible and safe in neonates weighing less than 1,000 g, providing a reproducible central venous access pathway when performed with a standardized micro-access protocol. WHAT IS KNOWN: • Centrally inserted central catheters offer superior performance compared to peripherally inserted central catheters in infants, although clinical data regarding their placement in micro-preterm neonates remain limited. WHAT IS NEW: • The right brachiocephalic vein caliber consistently exceeds 2.0 mm in neonates weighing < 1,000 g, and a standardized "micro-access" bundle yields high technical success without immediate mechanical complications.