Technique for insertion of percutaneous central venous catheters in the newborn period

G Bayley

doi:10.1136/fn.88.3.F256-b

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Technique for insertion of percutaneous central venous catheters in the newborn period

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Re: A novel way of inserting a percutaneous central venous catheter: The Townsville Method
T.H Koh
Published on: 22 March 2016
Re: A novel way of inserting a percutaneous central venous catheter: The Townsville Method.
Dr Naharmal Soni
Published on: 22 March 2016
Techniques for insertion of percutaneous central venous catheters in neonates
Peter A. Dargaville
Published on: 22 March 2016
A novel way of inserting a percutaneous central venous catheter: The Townsville Method.
T.H.H.G. Koh
Published on: 22 March 2016

Published on: 22 March 2016
Re: A novel way of inserting a percutaneous central venous catheter: The Townsville Method
- T.H Koh, Neonatologist
Dear Editor
We have inserted over 150 lines using the Townsville technique [1] (for babies as small as 500 gram birth weight) and had no problems with the 24 G cannula segment slipping into the vein. The disadvantage of leaving the hub is the possibility of a blood pool in it during the procedure. Another important reason is that it is easier and neater to secure the central line with Tegaderm without the potenti...
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Dear Editor
We have inserted over 150 lines using the Townsville technique [1] (for babies as small as 500 gram birth weight) and had no problems with the 24 G cannula segment slipping into the vein. The disadvantage of leaving the hub is the possibility of a blood pool in it during the procedure. Another important reason is that it is easier and neater to secure the central line with Tegaderm without the potential of the hub pressing on and abrasing the baby's skin.
As with any procedures in NICU insertion of percutaneous lines requires the baby to be kept still (a much shorter period using our method) with a small dose of sedative if need be, being careful and a normal blood glucose on the part of the operator. It is important to remember that the Premicath 27 G is only 200 mm long and may therefore be unsuitable for bigger babies.
Reference
(1) Gandini D, Koh THHG. A novel, simple way to insert percutaneous central venous catheters in newborn babies. J Perinatology 2003;23:162-163.
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
Re: A novel way of inserting a percutaneous central venous catheter: The Townsville Method.
- Dr Naharmal Soni, Specialist Registrar Paediatrics
- Other Contributors:
  Dr Sudeshna Byng (SHO Paediatrics)
Dear Editor
We read Dr Bayley's letter with interest, as we use a similar but probably safer technique to insert 27 guage lines (medex, vygon ). I was surprised at the author`s technique where the hub of the 24 guage canula was cut and then the long line passed through the plastic sleeve of the canula. We think this can be very dangerous as sometimes the thin plastic sleeve in front of the hub can be easily dislodge...
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Dear Editor
We read Dr Bayley's letter with interest, as we use a similar but probably safer technique to insert 27 guage lines (medex, vygon ). I was surprised at the author`s technique where the hub of the 24 guage canula was cut and then the long line passed through the plastic sleeve of the canula. We think this can be very dangerous as sometimes the thin plastic sleeve in front of the hub can be easily dislodged in to the vein in a baby who is vigorous during the procedure which may require surgical removal. We always insert our above long lines through a 24 guage canula and leave the hub which is easily fixed to the end of the long line unit and secured in place with a tegaderm. We do not really see any advantage of cutting the hub of the 24 guage canula. With our above technique, we do not have any increased risk of infection as compared to other longlines(23 and 24 guage vygon)that we use.
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
Techniques for insertion of percutaneous central venous catheters in neonates
- Peter A. Dargaville, Neonatologist
- Other Contributors:
  Grant Mackenzie
Dear Editor
We wish to amend and supplement the information supplied by Bayley [1] regarding the technique of insertion of central venous catheters in newborn infants. The report implied that the prescribed method for long line insertion in neonates at the Royal Children’s Hospital, Melbourne is that using a 19 FG butterfly needle. This is incorrect; no particular technique is stipulated as the preferred method, a...
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Dear Editor
We wish to amend and supplement the information supplied by Bayley [1] regarding the technique of insertion of central venous catheters in newborn infants. The report implied that the prescribed method for long line insertion in neonates at the Royal Children’s Hospital, Melbourne is that using a 19 FG butterfly needle. This is incorrect; no particular technique is stipulated as the preferred method, and data from our unit affirm that several methods are currently in use.
Over an 18 month period (July 2001-January 2003), we prospectively collected data on 107 episodes of silastic long line insertion (Epicutaneo -Cava-Katheter, Vygon GmbH, Aachen, Germany). 73 of the episodes (68%) were undertaken by senior neonatal trainees (Fellows), and 34 (32%) by paediatric registrars. For each episode, we documented the method or methods used for insertion of the line, the number of insertion attempts (i.e. number of separate venepunctures), and the outcome. A 19 FG butterfly needle was used for 73 attempts, and was successful on 39 occasions (53% success rate). Methods other than the 19 FG butterfly technique (including that described by Bayley) were used for 74 attempts, of which 41 (55%) were successful. Overall the silastic long line was successfully inserted in 79 episodes (74%), but required on average 1.7 separate venepunctures. Paediatric registrars successfully inserted the long line in only 16 out of 34 episodes (47%). These data highlight the difficulty presented by long line insertion in neonates, and the need for better methods to be developed.
The modified Seldinger technique described by Bayley has been used in our unit to insert silastic lines into the femoral vein for 7 years. We have not found it as useful for more peripheral veins, as the 20 FG IV cannula does not fit snugly over the guide wire, and its tip often catches in the skin or subcutaneous tissue, even if an incision is made at the puncture site. This difficulty may be potentially be overcome using a “piggy-back” technique where a 20 FG precut cannula sleeve is loaded onto a 24 FG cannula,[2] but the risk of cannula fragment embolisation will need to be overcome before this method can be widely recommended.
Although direct cannulation of the target vein using a 19 FG butterfly needle is difficult in small babies, some Neonatologists and senior Neonatal trainees are very successful in inserting long lines using this method. The butterfly needle is also used in some centres for long line insertion into the femoral vein, even in neonates less than 1000 grams.[3] Given the inherent risks associated with blind insertion of a 19 FG needle into the femoral triangle, we would not favour this method in very low birth weight infants.
References
(1) Bayley G. Technique for insertion of percutaneous central venous catheters in the newborn period. Arch Dis Child Fetal Neonatal Ed 2003;88:256-7.
(2) Fischer JE, Fanconi S. Percutaneous central venous catheterisation in premature infants: a method for facilitating insertion of silastic catheters via peripheral veins. Pediatrics 1998;101:477-9.
(3) Serrao PR, Jean-Louis J, Godoy J, Prado A. Inferior vena cava catheterisation in the neonate by the percutaneous femoral vein method. J Perinatol 1996;16:129-32.
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
A novel way of inserting a percutaneous central venous catheter: The Townsville Method.
- T.H.H.G. Koh, neonatologist
- Other Contributors:
  Simon Aung
Dear Editor
The Seldinger technique [1] of inserting a percutaneous central venous catheter (PCVC) had been published 10 years ago.[2]
We have recently published a novel, simple and quick technique, “The Townsville method,” which allows a PCVC to be inserted easily without the need for a butterfly needle or guide wire in any baby who has an indwelling peripheral intravenous cannula [3]: A 24-gauge c...
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Dear Editor
The Seldinger technique [1] of inserting a percutaneous central venous catheter (PCVC) had been published 10 years ago.[2]
We have recently published a novel, simple and quick technique, “The Townsville method,” which allows a PCVC to be inserted easily without the need for a butterfly needle or guide wire in any baby who has an indwelling peripheral intravenous cannula [3]: A 24-gauge cannula (BD Insyte, Becton Dickson, Utah) is inserted into the largest vein available. The stylet is removed and the hub of the cannula is cut off with sterile scissors. Care must be taken not to dislodge the cannula from the skin, or to let it slide too far into the vein. The 27-gauge silicone catheter (Premicath, Vygon, Germany) is introduced into the cannula and inserted to the required length. The 24-gauge cannula sleeve is then removed from the vein and skin, and pulled back as far as possible on the silicone catheter. The catheter and cut-off cannula are then fixed in place and chest Xray obtained to confirm position of the tip of the central line near the heart. The procedure is carried out using aseptic precautions with the operator masked and gowned. (Photos of the procedure are available).
Using our method anyone who can site a 24-gauge cannula in a baby will be able to insert a PCVC. Use of this technique has resulted in reduced blood loss in the babies. In comparison to previous techniques reported in the literature [1,2] we believe that the "Townsville method" is the simplest method of inserting a percutaneous central venous catheter in a sick newborn baby
Yours sincerely,
Koh THHG FRCPCH Neonatologist Aung S Registrar Regional Neonatal Intensive Care Unit The Townsville Hospital / James Cook University Queensland AUSTRALIA 4814
Acknowledgement: Method conceived whilst working with Dr Jonathan Shaw (who described the original method of siting neonatal PCVC) in University Colleg Hospital in 1984.
References
(1) Bayley G. Technique for insertion of percutaneous central venous catheters in the newborn period. Archives of Disease in Childhood Fetal and Neonatal Edition 2003;88:F256.
(2) Stephenson T, Khan J. A new technique for placement of central venous catheters in small infants. J Parenter Enteral Nutr 1993;17(5):479-80.
(3) Gandini D, Koh TH.A novel, simple way to insert percutaneous central venous catheters in newborn babies. J Perinatol 2003; 23(2):162-3.
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Conflict of Interest:
None declared.
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