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

Table 1 General clinical data of eight neonates with persistent left superior vena cava

Male: female (patients)	Gestational age (W)				Birth weight (g)				Age at PICC placement		Number of PICC procedures
	< 28	28-31+6	32-36+6	> 37	< 1 000	1000-1499	1500-2499	≥ 2500	≤ 24 h	> 24 h	For the first time	For the second time
5:5	1	3	3	1	2	3	2	1	5	3	7	1

PICC: Peripherally inserted central catheter.

Table 2 Information on eight neonates with persistent left superior vena cava who received a peripherally inserted central catheter

Serial number	Date of admission	Gestational age (W)	Birth weight (g)	Primary diagnosis	Age at PICC placement	Number of PICC procedures	Weight (g)	Puncture site	Placement length (cm)	First tip positioning	Adjustment situation	Reposition	Days of PICC indwelling (d)
Patient 1	May 22, 2017	32	1310	Preterm, very low birth weight	20 h	1	1310	Left basilic vein	13.5	T9	Pull out 2.7 cm	T5-6	8
Patient 2	July 13, 2017	40+2	2650	Postoperative esophageal atresia	10 d	1	2970	Left axillary vein	10	T7-8	Pull out 0.5 cm	T6	15
Patient 3	March 18, 2018	29+3	1200	Preterm, very low birth weight, patent ductus arteriosus	1 d	1	1200	Left basilic vein	12.5	T8	Pull out 0.8 cm	T5-6	18
Patient 4	November 9, 2018	34+1	975	Preterm, very low birth weight, atrial septal defect	1 d	1	975	Left basilic vein	12	T5-6	—	—	39
Patient 5	December 3, 2018	27+2	880	Preterm, very low birth weight, patent ductus arteriosus, tricuspid regurgitation (moderate)	32 d	2	1425	Left median vein	11	T6	—	—	10
Patient 6	December 26, 2018	36+4	2250	Postoperative esophageal atresia, preterm, low birth weight	3 d	1	2640	Left superficial temporal vein	12.5	T6	—	—	6
Patient 7	February 3, 2019	30+6	1220	Preterm, very low birth weight	1 d	1	1220	Left basilic vein	12.5	T9	Pull out 2.5 cm	T5	6
Patient 8	February 3, 2019	30+2	1500	Preterm, low birth weight	5 h	1	1503	Left axillary vein	8	T8	The lumen of the left superior vena cava was obviously smaller than that of the right superior vena cava, so the PICC was removed on the same day. The patient was scheduled for catherization through a lower extremity vein, but the family abandoned treatment 12 h after admission

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

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.