Use of centrally and femorally inserted central venous catheters in neonates: a nationwide survey of practices in French neonatal intensive care units.

UNLABELLED

The aim of this study is to assess the use of centrally and femorally inserted central catheters (CICCs and FICCs, respectively) in French neonatal intensive care units (NICUs) and to describe associated clinical practices. We conducted a national cross-sectional survey targeting all level III or higher NICUs in France. A link to an online questionnaire was sent to one member of the medical team in each unit between September and December 2024. CICCs were defined as central catheters inserted via the brachiocephalic or the internal jugular vein, and FICCs as central catheters inserted via the common femoral vein. All 65 NICUs participated in the survey. Of these, 45 (69.2%) reported performing CICC or FICC placements. Specifically, 35 (53.8%), 39 (60.0%), and 37 (56.9%) units performed insertions via the brachiocephalic vein, internal jugular vein, and common femoral vein, respectively. In most units, CICC/FICCs were used most frequently (n = 20) or systematically (n = 18) as a second-line option after an epicutaneo-caval catheter had been considered. In units that use CICC/FICCs, placement was performed by a NICU physician in 39 (86.7%) of them. In most cases, the catheter was placed under conscious sedation when feasible. The median minimum patient weight [interquartile range] considered suitable for central catheter placement was 1500 [800-2000] grams for brachiocephalic catheters, 1500 [900-2000] grams for internal jugular catheters, and 1650 [800-2000] grams for common femoral catheters. Very small caliber catheters (1 or 2 French in diameter) and a modified Seldinger insertion technique were used in 23 and 17 units, respectively.

CONCLUSION

CICC/FICCs use is part of clinical practice in most French NICUs, mainly as a second-line option. Indications for use, placement techniques, and maintenance protocols vary across units.

WHAT IS KNOWN

• Previous studies from specialized centers have shown that centrally and femorally inserted central catheters (CICC/FICCs) can be safely inserted in neonates. •It is still unclear to what extent these practices have been implemented in neonatal intensive care units.

WHAT IS NEW

• CICC/FICCs are now part of clinical practice in the majority of French NICUs. • The median minimum weight for CICC/FICC insertion was approximately 1500 g, indicating that their use has extended to smaller, more vulnerable infants. Very small-diameter catheters combined with a modified insertion technique enhance compatibility with neonatal vasculature.