Basilic Vein in Pediatrics

Peripherally inserted central catheters (PICC) serve as an efficient therapeutic strategy for conserving central venous access. The upper limbs provide at least three veins suitable for PICC insertion. Among these, the basilic vein is the most well known and frequently cannulated using anatomical guidelines. The optimal puncture site is identified as the mid-third of the arm, a region acknowledged in medical literature as ideal for minimizing complications related to bleeding or infection. I demonstrate the basilic vein puncture technique utilizing a short-axis (SAX) view, employing ultrasound-guided dynamic needle tip positioning (DNTP) for real-time guidance of the puncture. Mastery of DNTP is crucial for reducing the risk associated with SAX view punctures, often described as out-of-plane, and associated with complications due to the needle tip not being visualized. The puncture is performed with an intravenous catheter, which cannulates the vein (unlike the introducer needle, which only cannulates the tip), thus facilitating the manipulation of the guide once the entire catheter tube is cannulating the basilic vein. It is noteworthy that the intravascular catheter requires greater skill for visualization and tracking during puncture. Additionally, for PICC insertion, acquiring proficiency in the modified Seldinger’s technique is crucial, as delineated step by step in this chapter.