Peripherally inserted central catheter placement in neonates with persistent left superior vena cava: Report of eight cases

Table 3 Comparison of the traditional approach with the TIMB method

	Traditional approach	TIMB methods
Timing of PICC placement	On the day of birth	At least 24 h after birth, except for under special circumstances, such as rescue
Review of imaging data before catheterization	N/A	Retrospective analysis of imaging data should be performed before catheterization
Selection of the puncture site	The first choice is the basilic vein of the upper limbs, both left and right	The first choice is a lower limb vein; left upper limb and left scalp veins should be avoided in patients with PLSVC
Body surface measurement method	From the prepuncture point along the vein to the right sternoclavicular joint and down to the 1/2 intercostal space	In patients who were diagnosed with PLSVC by B-ultrasound before PICC placement, when a left-side puncture was required due to vascular conditions, the body surface length was measured from the left puncture point along the vein to the left sternoclavicular joint plus 0.5 cm. If we chose to insert the PICC from a lower limb or right limb, the body surface length was measured in the same manner as in the traditional approach
Whether under B-ultrasound guidance	No	Yes
Summary and challenges	Using this traditional approach will reduce the first-attempt success rate of PICC placement and limit the ability to discover cardiovascular abnormalities in a timely manner. The use of one measurement method could lead to the PICC tip position being too deep or too shallow. In addition, not using B-ultrasound guidance could also cause the PICC tip position to be too deep or too shallow	Using this new approach can improve the first-attempt success rate of PICC placement, reveal cardiovascular abnormalities in advance, allow the selection of different measurement methods reasonably according to the puncture site, and finally, improve the accuracy of catheter positioning through the use of B-ultrasound guidance. The new method, summarized after application in 8 neonates, still has certain limitations, and a large sample is needed for further research

PICC: Peripherally inserted central catheter; PLSVC: Persistent left superior vena cava.