In the severe, critically ill newborn, after the first days of intravenous treatment through the UVC, it is necessary to plan the placement of a CVC appropriate not only for standard infusions but also for high flow infusions, blood sampling, and possibly also hemodynamic monitoring. This can be achieved by ultrasound-guided insertion of power injectable polyurethane catheter - 3Fr or larger - either in the brachio-cephalic vein (CICC) or in the femoral vein (FICC).
Examples of indications to placement of a CICC or a FICC:
- Need for central access for rapid fluid repletion (in emergency and/or during major surgery).
- Hemodynamic instability and the need for monitoring of CVP and O2 saturation in mixed venous blood, at any age of life (in the impossibility of positioning a UVC or in the case of malpositioned UVC).
- Major malformation pathologies requiring surgery (e.g., esophageal atresia, omphalocele, gastroschisis, etc.).
- Infants with severe type 2 bronchodysplasia (need for mechanical ventilation at 36 weeks of postconceptional age) and need for intravenous therapy.
In the critically ill newborn, CICC or FICC should also be immediately placed when there are difficulties in positioning the UVC or in case of UVC-related complications (malposition, infection, thrombosis).