Neonatal long lines.

entral venous (CV) lines have been the subject of much professional debate and public exposure in the UK following an enquiry into the deaths of four children in Manchester as the result of cardiac tamponade. One of the recommendations of this review was that CV line tips should not be placed within the cardiac outline. 1 This has been the recommendation of CV line manufacturers for some time. In this issue, Beardsall et al report a retrospective questionnaire survey of pericardial effusion (PCE) and tampon-ade associated with percutaneously inserted central lines, together with a survey of current practice in percutaneously inserted central line use in neonatal units around the UK. 2 They compare the incidence of PCE in units with different approaches to the use of percutaneously inserted central lines. Despite likely ascertainment and response bias, and unknown confounders, this study adds an important piece to the complex puzzle of PCE. Their incidence of PCE of 1.8% in percutaneously inserted central lines is at the upper end of that reported in case series of 0.5–2.0%. 3 Most PCE occurred in units aiming to place the line tip in the caval veins; the risk was greatest in units with the lowest use of CV lines. The most important conclusion of this study is that, with the current approach to positioning of long lines, an attempt to site the line tip in the caval veins (rather than the right atrium) is not associated with a reduction in incidence of PCE. Several types of CV line are used in neo-natal care: (1) Umbilical venous catheters (UVC) (2) Peripherally inserted central lines (3) Central lines inserted over a guide wire at puncture of a large superficial vein (4) Surgically inserted central lines. Umbilical venous catheters These are relatively easy to insert in the newborn and have been used in sick neonates for a long time. They are generally 3–5 Fr gauge and made of poly(vinyl chloride) (PVC) or polyurethane. Multiple lumen UVCs have been used to reduce the need for peripheral venous access in very sick and in extremely pre-term infants. 4 Peripherally inserted central lines These are made of silicone or poly-urethane and are used commonly in neonates. Several developments have made the insertion technique easier: the two piece catheter joined by a hub, the peelable needle or cannula, and narrower gauge catheters. Central lines inserted over a guide wire These are usually …