The use of surgical central venous catheters in very low-birth weight neonates (under 1000 g)

Since 1985 we have been using central venous catheters (CVC) for Parenteral Nutrition (NPT) in the Neonatal Intensive care Unit (NICU) of our University. The CVC's are put in place surgically. In the last 5 years much greater use has been made of CVC in patients with very low birth weight (VLBW), absence of vascular access and important gastrointestinal problems. In the period between January 1985 and December 1990 this technique was used in 154 neonates applying 185 CVC's. Fifty one (33.1%) of these patients weighed less than 1000 g (Min 400) when the catheter was put in place. All catheters (Nutricath, Vygon I.D. 0.8 mm) used were inserted in the NICU. In the VLBW group the catheter was inserted in the external jugular vein in 11 cases (21.6%) and in the internal jugular vein in 40 cases (78.4%). Using the surgical technique we had a 100% success rate in this group. The mean duration of CVC was 23.5 days (range 1-113), 32 CVC's (62.7%) were removed as no longer required, 15 (29.4%) because patients died and 4 (7.8%) because of accidental dislodgement. In this period we had 7 cases (13.7%) of atrial thrombosis (AT) and 2 episodes of catheter-related sepsis (3.9%); however these complications were all successfully treated. In three cases a serious bradycardia was observed at sedation: this was solved with intensive care.