Tunneled Central Venous Lines in the Neonates: Insertion in the Neonatal Intensive Care Unit

Background/Purpose: The use of central venous catheters has brought enormous benefits in neonatal care. They have been used extensively in neonatal intensive care units for administration of intravenous fluids, parenteral nutrition as well as antibiotic therapy. Tunneling the catheter through the subcutaneous tissue has been used to reduce the incidence of systemic sepsis, as the skin exit site is away from the vein puncture site. Tunneled central venous catheters have been routinely inserted in the operating room, few centers performing the technique in the neonatal intensive care unit (NICU). The aim of this study was to evaluate the feasibility and safety of their insertion in the NICU. Patients and Methods: Over a period of two years, fourteen tunneled single lumen silicone catheters have been inserted by the author in 12 neonates. They were inserted using a cut-down technique either through the internal jugular vein or the femoral vein. Cases performed in the operating room received general anesthesia, while sedation and local anesthesia were used for cases performed in the NICUs. Postoperatively, X-ray was performed to verify the catheter position. Catheters inserted in the NICU were compared to those inserted in the operative room. Indications, complications and outcomes were reviewed. Result: The patients' weight ranged from 590 gm to 3.3 kg. The youngest was 7 days old. Six catheters were inserted in the operating room (43%), and eight (57%) in the NICU. The internal jugular vein was used in 12 cases (86%) and the femoral vein in two (14%). Of the twelve babies, ten (83%) required the catheter for hyperalimentation, and two (17%) for both antibiotic therapy and intravenous fluid administration. Septic complications occurred in two cases (14%); local wound sepsis in one patient (7%); and septicemia in another (7%). Both of them were inserted in the operative room. Tube dislodgement occurred in one case (7%) and thrombus formation in one occasion (7%). Conclusion: Tunneled insertion of central venous catheters is a valuable technique in the neonates. Line insertion in the NICU was not associated with increased risk of line sepsis. Therefore, performing the technique in the NICU is not only feasible but safe as well. However, large-numbered studies are still needed.