When placement of a PICC is contraindicated due to unavailability of the veins of the arm of adequate caliber and/or due to the presence of chronic renal insufficiency of grade 3b - 4 - 5 and/or for the presence of vascular, lymphatic, neuromuscular or osteo-articular to both arms, it will be necessary to resort to a CICC (that is, a central catheter inserted by ultrasound guided puncture and cannulation of a vein of the cervico-thoracic area or more precisely of the area above/below the clavicle).
The temporary immobility of the arms due to pharmacological effect (e.g. children under the effect of sedatives/muscle relaxants in intensive care) or the presence of acute renal failure (another frequent occurrence in intensive care) do not constitute a contraindication to PICCs. States of severe coagulation alteration do not constitute a contraindication to PICCs. There is no specific contraindication to the use of PICCs in children in intensive care, nor in the onco-hematologic patient: indeed, in these types of pediatric patients the PICC may have a specific indication compared to CICC, for example for the presence of tracheostomy or of one state of abnormal coagulation.