Ultrasound-Guided Centrally Inserted Central Catheter (CICC) Placement in Newborns: A Safe Clinical Training Program in a Neonatal Intensive Care Unit

Abstract

Background: Centrally inserted central catheters (CICCs) are increasingly used in neonatal care. CICCs have garnered attention and adoption owing to their advantageous features. Therefore, achieving clinical competence in ultrasound-guided CICC insertion in term and preterm infants is of paramount importance for neonatologists. A safe clinical training program should include theoretical teaching and clinical practice, simulation and supervised CICC insertions.

Methods: We planned a training program for neonatologists for ultrasound-guided CICCs placement at our level III neonatal intensive care unit (NICU) in Modena, Italy. In this single-centre prospective observational study, we present the preliminary results of a 12-month training period. Two paediatric anaesthesiologists participated as trainers, and a multidisciplinary team was established for continuing education, consisting of neonatologists, nurses, and anaesthesiologists. We detail the features of our training program and present the modalities of CICC placement in newborns.

Results: The success rate of procedures was 100%. In 80.5% of cases, the insertion was obtained at the first ultrasound-guided venipuncture. No procedure-related complications occurred in neonates (median gestational age 36 weeks, IQR 26-40; median birth weight 1200 g, IQR 622-2930). Three of the six neonatologists (50%) who participated in the clinical training program have achieved good clinical competence. One of them has acquired the necessary skills to in turn supervise other colleagues.

Conclusions: Our ongoing clinical training program was safe and effective. Conducting the program within the NICU contributes to the implementation of medical and nursing skills of the entire staff.

Keywords: central venous catheterization; critically ill neonates; neonatal intensive care; neonates; neonatology; simulation; training; ultrasound guidance.

Figure 1

RACEVA protocol. Pre-operative US scan with the so-called RACEVA (Rapid Central Vein Assessment) protocol. (A) Systematic US examination of the veins in the supra-clavicular/sub-clavicular area; (B) US localization of CA and IJV; (C) US localization of BCV and SV. Abbreviations. BCV: brachio-cephalic vein; CA: carotid artery; IJV: internal jugular vein; SV: subclavian vein; SX: left; US: ultrasound.

Figure 2

CICC placement procedure. (A) Sterile field preparation (A.1), barrier precautions and skin antisepsis with 2% chlorhexidine in 70% isopropyl alcohol (A.2); (B) US-guided venipuncture of the BCV by the supraclavicular approach (visualization in the long-axis); (C) vein cannulation using the modified Seldinger technique (C.1) and a micro-introducer kit (C.2), introduction of polyurethane 3 Fr double lumen catheter (C.3); (D) US-based tip navigation; (E) application of cyanoacrylate glue for the closure of the puncture site and for the sealing of the exit site; (F) securement with suture-less device and coverage of the exit site with a transparent membrane. Abbreviations: L-BCV (left-brachiocephalic vein).