Right Brachiocephalic Vein in Neonates

The right brachiocephalic vein (RBCV) is a significant retroclavicular/sternal vein, oriented vertically toward the superior vena cava. Its puncture is conducted in a long-axis (LAX) view from the supraclavicular fossa to implement the dynamic needle tracking (DNT) technique. In neonates, the supraclavicular fossa is notably small, necessitating proper positioning with a scapular roll to enlarge the space between the mandible and clavicle, thereby facilitating adequate ultrasonographic exploration of the retroclavicular/sternal space. Cannulation of the RBCV is technically more demanding compared to the left, as the direction of the introducer needle is nearly parallel to the insonation area of the transducer. The pleura is adjacent to the posterior and lateral aspects of the RBCV. Due to its deep location, the BCV cannot be easily compressed in the event of bleeding due to coagulation disorders, thus representing a contraindication for its puncture.