Cephalic Vein in Pediatrics

Peripherally inserted central catheters (PICC) serve as an effective therapeutic strategy for optimizing central venous access, also providing an access route for midline catheters. The upper limbs contain at least three veins suitable for PICC insertion. The cephalic vein, located on the outer aspect of the arm and superficial within the subcutaneous tissue, achieves a sufficient caliber primarily in adolescents. Utilizing a tourniquet near the axillary region can enhance its visualization. I demonstrate the cephalic vein puncture technique using a short-axis (SAX) view, employing ultrasound-guided dynamic needle tip positioning (DNTP) for real-time guidance of the puncture. Mastering DNTP can reduce the risk associated with SAX view puncture, which is often described as out-of-plane and linked to complications arising from inadvertent punctures due to the needle tip not being visualized. 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.