Clinical experience of percutaneous femoral venous catheterization in critically ill preterm infants less than 1,000 grams

Background: Venous access is relatively difficult in preterm infants. Central venous catheterization is indicated for pressure monitoring, drug therapy, and nutrition supplementation, which are often critical in the anesthetic management of infants undergoing major surgery. Methods: In 49 critically ill preterm infants weighing less than 1,000 g, the femoral vein was cannulated using a 22-gauge Angiocath (25 min; Beckton Dickinson, Sandy, UT). A 2.5-ml syringe was attached to the Angiocath, and the Angiocath was advanced with constant negative pressure over the syringe. When blood return was observed, the cannula was advanced . When free blood reflux was achieved, a J wire was inserted, followed by a 24-gauge central venous catheter. Results. The overall catheterization success rate was 79.6% (39 of 49 attempts). The time required for successful catheterization was less than 10 min in 18 cases (46.2%), 10-20 min in 17 cases (43.6%), and 20-30 min in 4 cases (10.3%). In the successful group, I catheter tip was positioned in the vein of the liver (2.6%), 2 were in the common iliac vein (5-1%), 6 were in the right atrium (15.4%), and 30 were in the infracardiac inferior vena cava (76.9%). Complications included hematoma in six cases (12.2%), arterial puncture in five cases (10.2%), bleeding in two cases (4.1%), and transient bradycardia in two cases (4.1%). Conclusions. The results indicate that percutaneous femoral venous catheterization is a reliable and valuable technique for critically ill preterm infants weighing less than 1,000 g.