Any central venous access in the pediatric patient (as in adults) must be placed using ultrasound.
The 'blind' puncture of the subclavian or internal jugular vein is now considered a senseless, dangerous, ethically questionable and legally prosecutable practice.
The positioning of central accesses by venous cutdown - used in the 20th century - is now completely obsolete, and it is associated with a greater risk of complications (infectious, thrombotic, hemorrhagic, etc.), longer times, and higher costs.
When the deep veins of the arm are available at ultrasound examination (at least on one side), the preferable CVC - also in the pediatric age - is the PICC. This access is in fact particularly free from risks of significant complications to the insertion, it can be implanted even in very fragile children from the cardiorespiratory or coagulative point of view, and it implies an exit site (at mid-arm) particularly favorable both for the low bacterial contamination of the skin both for its easy dressing. Furthermore, the placement of PICCs in pediatric age has the additional advantage of being associated with less need for sedation/anesthesia, compared to the placement of a CICC.
As in the adult, also in children the main contraindications to the placement of a PICC are:
- the presence of a chronic renal failure of grade 3b -4 - 5 (i.e., likely current or future need for chronic hemodialysis treatment)
- the (bilateral) presence of various types of pathologies of the upper limb, vascular (previous or current venous thrombosis), lymphatic (previous axillary lymphadenectomy), neuromuscular (paresis or chronic plegia), cutaneous (burns or other skin lesions , infectious or dystrophic), osteo-articular (ankyloses, fractures, etc.).