For anyone who has ever struggled placing a central line in a pediatric patient, I sincerely hope you find a pearl or two in this section. At this point, few will argue about the benefits of performing central lines with the aid of ultrasound. While certainly there are downsides, namely having access to an ultrasound machine and becoming comfortable with the technique, it is well established that the use of ultrasound in vascular access results in a higher “first pass” success rate, fewer complications, and a higher overall success rate. For many institutions, it is the standard-of-care.
Just like in adults, the mainstays of central access include: internal jugular, subclavian, and femoral veins. With the advent of ultrasound, central access, even in preterm neonates, has been fairly successful. That is not to say that it is without challenge. Rather than go through the mechanics of placing central lines, I will really just touch on clinical pearls that will may help in your next endeavor.
