Left Femoral/Iliac Vein in Neonates

The femoral vein is a frequently utilized central venous access point, preferred for its anatomically consistent location with minimal variations. A predominance of one side often exists; thus, the rapid femoral vein assessment (RaFeVA) is recommended during pre-procedural evaluation. Ultrasound-guided puncture techniques can be performed using either a long-axis (LAX) or short-axis (SAX) view. In this chapter, I demonstrate the puncture in LAX view using ultrasound-guided dynamic needle tracking (DNT) to facilitate real-time guidance of the intravenous catheter (24 G) until venous cannulation is achieved. In neonates, due to the vessels’ shorter length, femoral vein punctures often involve the iliac vein, which cannot be visualized with anatomical guidelines. However, this chapter illustrates how the iliac vein, situated above the femoral head, is perfectly visualized by ultrasound, with the venous catheter extending to this vessel, that is, 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 medial distribution of the vein relative 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 the necessary clues to distinguish the femoral or iliac vein from their respective arteries.