Supraclavicular approach central line catheterization in low-birth weight premature neonate

Abstract

Introduction: Intravenous catheterization is challenging in neonates, especially in the low-birth-weight population. Most patients were referred to the anesthesiologist after several failed attempts at central vein catheterization. In this case report, we would like to share an unusual approach with a higher success rate.

A one-day old female child, 1.7 kg, with gastroschisis and neonatal sepsis. The patient's general condition was weak and lethargic, with HR 135 bpm, RR 50 tpm, SpO₂ 95% on ventilator and prolonged hemostatic function. The patient was prepared for central venous catheter insertion. The right neck was disinfected, and lidocaine (2%, 0.1 ml) was administered. It started with the insertion of a 24 G IV catheter, which was then aspirated with blood. Guidewire was advanced then dilated before the insertion of CVC 3 Fr for 10 cm. The catheter was then fixed using a 3.0 silk suture. Postoperatively, the patient was radiographed without further bleeding.

The patient was given midazolam 1,5 mg, fentanyl (30 mcg), and sevoflurane (8 vol%) in 100% oxygen with a face mask size 2 until an adequate level of anesthesia with spontaneous ventilation was achieved. The patient was then placed in the left lateral decubitus position. The insertion site was marked at L1 to cover T6–S2. A catheter was inserted 10 cm before the test dose and an incremental dose of ropivacaine 0.2% 7 ml, then maintenance at 3 ml/h. Hemodynamics were stable with SpO2 97-100%, HR 97–103 bpm, SBP 80-90/45-47 mmHg.  Postoperatively, the patient was transferred to the PACU.

The supraclavicular approach can be used for neonates in whom it is difficult to find other sites for CVC insertion, as  it is easier for the physician to reach the deeper vein from easier approach.

Keywords: Central Venous Catheter, Supraclavicular Approach, Pediatric Anesthesia

Citation: Rifani A, Ahmad B, Husain TA, Semedi BP. Supraclavicular approach central line catheterization in low-birth weight premature neonate. Anaesth. pain intensive care 2026;30(3):389-394. DOI: 10.35975/apic.v30i3.3183

Received: April 24, 2025; Revised: October 30, 2025; Accepted: January 01, 2026