The ultrasound-guided positioning of a CICC in emergency implies the puncture and cannulation of deep veins of the supra/infra-clavicular area. In the supraclavicular area, we can appropach the internal jugular vein (preferably, visualization in short axis and 'in plane' puncture), the subclavian vein (visualization in long axis and 'in plane' puncture) or the brachio-cephalic vein (visualization in long axis and 'in plane' puncture). In the infra-clavicular area, the only approach is usually to the axillary vein (visualization in oblique/long axis and 'in plane' puncture; or visualization in short axis and 'out of plane' puncture).
Also in the pediatric patient, the choice of the vein should be based on the RaCeVA protocol (Rapid Central Vein Assessment), i.e. the rapid and systematic examination of the main deep veins of the area above/below the clavicle, so to identify the vein that appears to be the easiest to puncture ( and therefore the safest for the patient). In the hypovolemic child, the internal jugular and axillary veins are often collapsed and more difficult to cannulate.
The ease of the venous approach also depends on the age of the child: in the infant the easiest and safest veins will be the brachio-cephalic and the internal jugular vein.
CICC are made of low-cost polyurethane, and they are usually inserted by simple Seldinger technique. The number of lumens will be determined by clinical needs.
Any emergency CICC should preferably be removed within 24-48 hours.