Safety and Feasibility of Ultrasound-Guided Brachiocephalic Venipuncture for Centrally Inserted Central Catheters in Newborns

BACKGROUND: Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein (BCV) is a promising approach for neonatal central venous access, although multicenter data on feasibility, safety, and reproducibility remain limited. RESEARCH QUESTION: In critically ill neonates requiring centrally inserted central catheters (CICCs), is ultrasound-guided supraclavicular BCV access feasible across centers, and is it associated with low procedural and catheter-related complication rates? STUDY DESIGN AND METHODS: This retrospective multicenter observational study was conducted in three Level III neonatal ICUs in Italy and included 361 BCV venipunctures for CICC placement from January 2022 to December 2025. Demographic, procedural, and outcome data were collected from electronic and paper records. Primary outcomes were immediate procedural complications, venipuncture attempts, first-attempt success, and catheter dwell time; secondary outcomes included catheter-related bloodstream infection, mechanical complications, and secondary malposition. Analyses were descriptive. RESULTS: Median weight at insertion was 2,500 g, and median age was 16 days; median catheter dwell time was 20 days, yielding 10,575 catheter-days of follow-up. All 361 CICCs were successfully placed. First-attempt success occurred in 325 procedures (90.0%), and the mean number of venipuncture attempts was 1.1 per patient. No immediate major complications occurred, including arterial puncture, pneumothorax, or hemothorax. Catheter-related bloodstream infection occurred in 18 catheters (4.9%; 1.7 per 1,000 catheter-days), mechanical complications in 15 (4.1%), and secondary malposition in 10 (2.7%). INTERPRETATION: Ultrasound-guided supraclavicular BCV catheterization was feasible, reproducible, and associated with low immediate complication rates across 3 neonatal ICUs. These findings support this technique as an effective option for neonatal central venous access when performed within a standardized ultrasound-guided protocol.