Brachial Vein in Pediatrics

Peripherally inserted central catheters (PICC) represent an effective therapeutic strategy for conserving central venous access, also serving as access points for midline catheters. The upper limbs offer at least three veins suitable for PICC insertion. Typically, the arm contains two brachial veins accompanying the brachial artery, with one tending to be dominant. The mid-third of the arm is recognized in the literature as the optimal puncture site to minimize complications related to bleeding or infection. I describe the puncture technique for the left brachial vein using a long-axis (LAX) view, employing ultrasound-guided dynamic needle tracking (DNT) for real-time puncture guidance. For the insertion of a PICC, it is necessary to learn the modified Seldinger’s technique, which we demonstrate step by step in this chapter. Various PICC devices are available, each with specific advantages and disadvantages, making it crucial to be familiar with their characteristics.