Proximal trimming and retrograde tunneling for neonatal central venous access: An atypical over the wire approach from a single center experience

Tunneled central venous access devices (T-CVADs) are used in selected neonatal cases, and their placement often requires a peel-away introducer. In premature infants and neonates, when the introducer is significantly larger than the catheter, the procedure may be technically challenging because of the small size and fragility of the veins. This study describes a modified technique for T-CVAD placement in neonates weighing less than 5 kg. The proposed approach combines a Seldinger over-the-wire insertion with retrograde tunneling and proximal trimming, with the aim of avoiding the use of a peel-away introducer and simplifying catheter placement. Eight neonates underwent T-CVAD placement using this technique. No procedure-related adverse events or early catheter migration were observed. Most catheters (7/8) were removed at the end of the prescribed therapies, while one was removed due to late tip migration. Overall, the Seldinger over-the-wire insertion appeared feasible, safe, and effective in this small case series. The combination of proximal trimming and retrograde tunneling allowed accurate catheter length adjustment, reduced the risk of dislocation, and preserved the catheter's tapered tip, without observed procedure-related complications.