Left Brachiocephalic Vein in Neonates

The left brachiocephalic vein (LBCV) is a prominent retroclavicular vein that traverses transversally from left to right, originating from the confluence of the left internal jugular vein and the left subclavian vein. In neonates, it 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 space. Cannulation is executed utilizing a long-axis (LAX) view from the left supraclavicular fossae, employing the dynamic needle tracking (DNT) technique. The procedure involves the use of an intravenous catheter aimed at full cannulation of the vein with the catheter tube. Unlike the right brachiocephalic vein puncture, the intravenous catheter for accessing the LBCV is entirely visualized in-plane, facilitating cannulation while preventing penetration of the posterior wall and the adjacent pleura. Despite its superficial nature, the vein’s retroclavicular location makes compression unfeasible in the event of bleeding from coagulation disorders. Therefore, attempting access in patients with such conditions is contraindicated.