The establishment of safe and functional intravenous lines is of fundamental importance in premature sick neonates. Due to technical difficulties and various potential complications, central venous catheterization(CVC) has become an important part of long term care for prematurity. In terms of safety, it is believed by some that the central vein catheter tip should not be in the right atrium to avoid fatal complications. However, catheter performance and durability can be improved by positioning the catheter tip within the right atrium. Here, we evaluated the effectiveness of intraatrial catheter tip positioning for prematurities, to resolve this controversy between patient safety and catheter performance.

Premature neonates in whom CVC had been attempted at a nursery and pediatric intensive care unit were enrolled in this study. We successfully performed eighteen CVCs in twenty patients from September 2003 to December 2004. CVC tips were in positioned within the right atrium, and central venous route, central venous catheter depth, duration of catheterization, and any complications during or after catheterization were evaluated.

Eighteen CVC were successful among twenty attempted in premature neonates. Two attempts failed due to guidewire insertion failure. A left supraclavicular venous approach was selected for 16 patients and a right approach for two. For intraatrial tip positioning, distances from skin to catheter tip were adjusted to an average depth of 5 cm in 11 patients and 6 cm in three patients. Two arterial punctures were the only minor complications. Mean duration of catheterization was 19 days without any long term complicaions.

To prematue long term CVC performance, left supraclavicular subclavian vein catheterization and intraatrial catheter tip positioning should be considered a first option in premature neonates.