Vascular access in neonates and children: Techniques for the pediatric surgeon.

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. As PICC lines have become more ubiquitous, the current generation of pediatric surgeons has less experience with traditional techniques, which are now typically reserved for situations in which it is not possible to place a PICC. Additionally, vascular access techniques for patients with fragile skin conditions, such as epidermolysis bullosa and for hemodialysis access in the neonatal population will also be addressed. By reviewing these techniques and their indications, we aim to provide a resource for pediatric surgeons facing complex vascular access challenges.