We want to thank Dr. Brock-Utne for his valuable contribution. Undoubtedly, pericardial effusion with ensuing tamponade is a possible complication of any central venous catheter with a high mortality.1  Peripherally inserted central venous lines may even carry a greater risk due to catheter tip migration with changes of arm position.2 

However, the purpose of our analysis was to demonstrate the relative ease and safety of supraclavicular, ultrasound-guided brachiocephalic vein cannulations in preterm infants without including any long-term complications as of yet.3  In 155 brachiocephalic venous catheters in babies less than 2.5 kg, we have not observed a pericardial effusion. The best way to avoid a pericardial effusion caused by central venous lines and other major complications is to follow, e.g., the Italian vascular access guidelines,4  which also propose the correct catheter tip position in the cavoatrial junction preferentially by the use of echocardiography or intracavitary electrocardiography.

The author declares no competing interests.

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