Vascular Access in Neonates and Children: Techniques for the Pediatric Surgeon

jpedsurg.org

Vascular access in infants and small children can be challenging, particularly when standard techniques are unavailable or unsuitable. In this manuscript, we describe alternative approaches for establishing vascular access in pediatric patients, especially those with conditions that contraindicate conventional access methods. These techniques were used routinely before the widespread adoption of peripherally inserted central catheters (PICC) lines. While a surgeon certainly is capable of placing a PICC line, these procedures are generally performed by non-physicians as part of a vascular access team.

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Article · Jan 2026 · 1 min read

In brief

This article reviews alternative surgical techniques for establishing vascular access in neonates and small children when standard methods like PICC lines are contraindicated or unavailable. It covers historical and contemporary approaches that pediatric surgeons can employ in challenging clinical scenarios requiring central venous access.

Alternative vascular access techniques remain essential when PICC lines are contraindicated or unavailable in pediatric patients.
Surgeons should maintain proficiency in pre-PICC era techniques for challenging neonatal and small-child vascular access scenarios.
Non-physician vascular access teams now routinely place PICC lines, shifting surgeon focus to complex alternative access methods.

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