Comparison of ultrasound-guided brachiocephalic and internal jugular vein cannulation in neonates and infants: A prospective randomized controlled trial

Abstract Background and Aims: Central venous cannulation in neonates and infants is technically challenging due to small vessel size and vein collapsibility. Although ultrasound-guided (USG) internal jugular vein (IJV) cannulation is commonly used, supraclavicular in-plane brachiocephalic vein (BCV) cannulation has emerged as a newer approach with several advantages because of its straighter course, larger diameter, and reduced collapsibility. The aim of this study was to compare the USG-guided in-plane IJV vs supraclavicular in-plane BCV cannulation in neonates and infants. Material and Methods: This prospective randomized controlled trial (RCT) was commenced after obtaining institutional ethical clearance (EC/OA-67/2022) and registered with CTRI (REF/2023/08/071780). A total of 80 neonates and infants satisfying the eligibility criteria were included for this study, with 40 each being randomly allotted either to group A (USG in-plane right IJV cannulation) or group B (USG supraclavicular in-plane left BCV cannulation). Written informed parental consent was obtained for all the participants. The primary outcome was 1 st attempt success rate. Secondary outcomes included cannulation time, number of attempts, overall success rate, and complications. Results: First-attempt success rate was higher in BCV than in the IJV group (95% vs 77.50%, P value = 0.02) (95% CI: 3.2–31.8). Cannulation time was less in the BCV group (50.70 ± 58.51 secs vs 86.63 ± 60.19 secs: P value < 0. 008) (95% CI: −62.5 to −9.3) as compared to the IJV group. Overall success rate was slightly higher in the BCV group (100% vs 97.50%, P value = 0.31) (95% CI: −2.4% to 7.4%) along with a reduced number of attempts (1.08 ± 0.35 vs 1.30 ± 0.65, P value = 0.057) (95% CI: −0.45 to 0.01). No immediate or late complications (within 48 hours) were observed in both the groups. Conclusions: USG in-plane left BCV cannulation improved first-attempt success rate and cannulation time as compared to in-plane right IJV cannulation with a reduced number of attempts. Brachiocephalic central venous cannulation may have advantages over IJV access, especially in critically ill neonates and infants, making it a feasible and safe alternative to IJV.