Vascualr Access in neonate

[ammar]

Hi

I would like to review with you, what kind of central vascular acess in neonates in managing preterm or term infant with severe RDs/PPHN.
sometimes we have difficulty to make central un ombilical venous KT, so we remove it immediatly and we place either jugular or femoral acess for term neonate and Epicutaneocava KT in preterm. But as you know, especially in term neonate with severe PPHN, the time of catheterism is a usual occasion for oxygenation loss.
So what do you do in such situation.

Thanks

Khaldi Ammar
Children's Hospital of Tunis
PICU

[Stefan Johansson]

In acute situations we mainly rely on arterial access via umbilical arterial catheter, and if not possible to a peripheral arterial catheter (preferably radial catheter).
For venous access in the acute phase we mainly use umbilical venous access, and if not possible peripheral venous access. We may go for a percutaneous peripherially inserted central catheter (i.e. regular peripheral venous catheter first, then we insert a 27G line through the PVC to a central position), but those are mainly used for parenteral nutrition.

I guess we could learn better central venous techniques though.