Right Femoral/Iliac Vein in Neonates

The femoral vein is a central venous access commonly utilized due to its anatomical consistency and limited variability. Ultrasound-guided puncture techniques can be performed using either a long-axis (LAX) or short-axis (SAX) view. In this chapter, I demonstrate the LAX view puncture employing ultrasound-guided dynamic needle tracking (DNT) to guide the puncture in real time, enabling the complete tracking of the intravenous catheter (24 G) until venous cannulation. In neonates, due to the short length of the vessels, femoral vein punctures often involve the iliac vein, which cannot be visualized with anatomical guidelines. However, this chapter reveals how the iliac vein, located above the femoral head, is perfectly visualized by ultrasound, with the intravenous catheter reaching this vessel, i.e., above the inguinal ligament. The most challenging aspect of this technique involves precise alignment of the introducer needle with the transducer’s insonation area. In this age group, the vein’s medial distribution to the artery is almost imperceptible, especially in preterm infants where vessel diameters are less than 0,2 cm. Compression maneuvers and anatomical differentiation of the artery, which divides distally into the superficial and deep femoral arteries, and the saphenous vein converging into the femoral vein may provide clues to differentiate the femoral or iliac vein from their respective arteries.