In the newborn, the easiest and safest supra-clavicular vein available for ultrasound-guided puncture and cannulation is always the brachio-cephalic vein. Even in premature infants, the caliber of this vein is approximately 3 mm, which allows the placement of a 3Fr power injectable polyurethane catheter.
Insertion must be carried out according to the SICA-Ped protocol developed by GAVeCeLT: ultrasound evaluation of all central veins (RaCeVA); maximum barrier precautions; skin antisepsis with chlorhexidine 2% in alcohol; ultrasound-guided venipuncture (in the case of the brachio-cephalic vein: visualization in long axis and 'in plane' puncture); tip navigation by supra-clavicular ultrasound scan; tip location by intracavitary ECG technique and/or echocardiography; sutureless securement; coverage of the exit site with cyanoacrylate glue and transparent semipermeable dressing with high transpirability. Furthermore, in the newborn it is always advisable to tunnel the catheter so that the exit site is in the infra-clavicular area, even if the puncture site in the supraclavicular area.
For best tunneling, we recommend the off-label use of central catheters marketed as PICC (3Fr single lumen or 4Fr bi-lumen): these catheters are in power injectable polyurethane, high flow, and they are inserted by modified Seldinger technique (which makes the tunneling easier).
Such CICCs can be used not only for normal infusions, but also for high flow infusions, for blood transfusion, for blood sampling and for hemodynamic monitoring (as long as the tip is positioned in the right atrium).