Indian Journal of Pediatrics, Volume 76—September, 2009 965
Scientific Letters to the Editor
Central venous catheterization or the placement of long
lines is becoming more common in neonatal set ups.
Indications for central line placement in neonates
include difficult IV access, need for prolonged IV
therapy and total parenteral nutrition.1 In specialized
cardiac set ups, these lines can be used for monitoring
central venous pressures. Inserting central lines
through the femoral route in small and sick newborns
is challenging, and has a complication rate
significantly higher than insertions in older children,
owing to the limited caliber of the neonatal femoral
vein.1 In our Institute, we have been inserting central
lines through a percutaneous femoral route in neonates.
The technique is safe, 1,2 does not need a C-arm, and
has proved not to increase the incidence of infections.2
The lines used included Leaderflex 22 G (Vygon) and
Arrow single lumen 22G catheter.
Although the accepted and time honored technique
for the placement is based on Seldinger’s method, we
found that introduction of the guide wire through the
wide bore needle supplied in the kit was difficult owing
to the small caliber of the neonatal femoral vein, with
minimal movement leading to a counter puncture or the
needle slipping out of the vein. The observation that the
guide wire of the device used would pass equally well
through the sheath of a 22 guage venflon prompted us to
modify the technique with excellent placement results.
After sterile preparation and adequate restraint and
/or sedation, a 22 G veflon is used to make the initial
femoral venipuncture, the sheath and the stilette being
mounted on a 5ml syringe filled with saline. Once
Modification of Seldinger Technique for Introduction of
Femoral Lines in Newborns
venous blood is aspirated, the cannula is introduced
fractionally in, and the stilette is withdrawn. The
syringe is now connected to the venflon sheath and
saline is pushed to make sure that the cannula is in
place. While flushing the cannula, it is gently advanced
into the vein, until the entire sheath has been placed.
Aspiration of blood and free flow confirm that the
venflon is indeed in the vein. Now it is a simple matter
to put the guide wire into the vein through the venflon,
remove the venflon and thread the catheter into the vein
after using a vein dilator. Flushing the catherter,
fixation and dressing complete the procedure.
Using this slight modification, the author has been
able to successfully place 22G femoral lines
percutaneously in babies weighing as little as 800 g. The
author believes this modification enhances the safety of
the procedure and increases the success rate of femoral
placement of central lines.
Dr Anindya Chattopadhyay
Department of Pediatric Surgery
Dr. BC Roy Memorial Hospital for Children
Narkeldanga Main Road, Kolkata, India
E Mail: email@example.com
1. Rao S, Alladi A, Das K, Cruz AJ. Medium and long term
venous access in children. Indian Pediatrics 2003; 40:41-44.
2. Stenzel JP, Green TP, Fuhrman BP, Carlson PE,
Marchessault RP. Percutaneous femoral venous
catheterizations: a prospective study of complications. J
Pediatr 1989; 114:411-415.
as ACEI and furosemide should warrant periodic
assessment of renal function, particularly serum
creatinine. In such conditions if renal failure goes
unrecognized, toxicity of drugs excreted through the
kidneys can be more fatal than renal failure itself and
can occur even without elevated levels of the drugs in
Sheetal Mehta and M. Vijayakumar1
1Consultant Pediatric Nephrologist
Kanchi Kamakoti CHILDS Trust Hospital
Chennai – 600 034, India
1. Sorrentino KJ. Drug therapy for congestive heart failure.
Appropriate choice can prolong life. Post Graduate Med 1997;
2. Cooke HM, Besse DA. Angiotensin-converting enzyme
inhibitor induced renal dysfunction: Recommendations for
prevention. Int J Clin Phamacol Ther 1994; 32: 65-70.
3. Schoolwerth AC, Sica Da, Ballermann BJ, Wilcox CS. AHA
Scientific Statement Renal Consideration in Angiotensin-
Converting Enzyme Inhibitor Therapy. Circulation 2001; 104:
Scientific Letters to the Editor