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. Centr al venous catheterization is indicated for pressure monitoring, drug therap y, and nutrition supplementation, which are often critical in the anestheti c management of infants undergoing major surgery. Methods: In 49 critically ill preterm infants weighing less than 1,000 g, t he 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 bloo d reflux was achieved, a J wire was inserted, followed by a 24-gauge centra l venous catheter. Results. The overall catheterization success rate was 79.6% (39 of 49 attem pts). 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 cas es (10.3%). In the successful group, I catheter tip was positioned in the v ein 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 cav a (76.9%). Complications included hematoma in six cases (12.2%), arterial p uncture 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 catheter ization is a reliable and valuable technique for critically ill preterm inf ants weighing less than 1,000 g.