Guía práctica para la colocación ecográfica de accesos venosos y arteriales en pediatría. Recomendaciones GAVA

CRITICAL CARE & EMERGENGY MEDICINE VOL. 5

Practical guide for ultrasound-guided placement of venous and arterial access in pediatrics. GAVA Recommendations

Enviar Artículo

www.doi.org/10.58281/ccem060126-rev-nar-10

Javier Ponce 1 , Edgar Ramón Chávez Robles 2 , María Cecilia Garcia 3 , Daniela Patricia Vallejos Vidal 4 , Luis Fernando Sabajan Gómez 5 , Kasey Fuentes Bernal 6 , Lellis Figueroa 1 , Alfredo Carlos Rodríguez-Portelles 7 , David Pascual Rojas Flores 8 , Rielka Marietta Miranda Isaguirre 9 .

1 Hospital Dr. Guillermo Rawson, San Juan, Argentina. Miembro fundador USPed Latinoamérica.
2 Hospital del Niño Morelense, Emiliano Zapata, México. Miembro fundador USPed Latinoamérica.
3 Hospital de Pediatría J. P. Garrahan. Miembro fundador USPed Latinoamérica.
4 Hospital general de niños “Pedro de Elizalde”. Miembro fundador USPed Latinoamérica.
5 Instituto Guatemalteco de Seguridad Social, Guatemala.
6 Hospital del Niño Dr. José Renán Esquivel, Panamá.
7 Hospital Metropolitano, Quito, Ecuador. Miembro fundador USPed Latinoamérica.
8 Hospital General Regional No. 1 del Instituto Mexicano del Seguro Social, Querétaro. Miembro fundador USPed Latinoamérica.
9 Hospital Victoria Motta, Jinotega, Nicaragua.

Editor
Manuel Alberto Guerrero Gutierrez , Lizeth Tapia .

Chair
Diego Escarraman Martinez .

Abstract

Abstract: Vascular access is essential in critically ill pediatric patients for the administration of life-saving treatments, monitoring, and blood sampling. Traditional placement of venous and arterial access based on anatomical landmarks is associated with complications due to its blind execution. Bedside ultrasound has revolutionized the practice, allowing real-time visualization of the vessel and needle, increasing success rates, and reducing complications. A standardized guide is presented
for vascular access placement, which includes prior evaluation, equipment preparation, positioning of the operator and the vessel to be used, ultrasound-guided puncture, catheter placement, and post-procedure verification.
The most common access modalities (internal jugular vein, subclavian, and femoral), unusual situations, arterial catheters, early detection of complications, and the final position of the catheter’s distal tip are included, there by improving safety and effectiveness, and reducing the need for radiation exposure. Additionally, the importance of simulation-based training and standardization of the procedure to maintain safety and effectiveness is emphasized.

The use of ultrasound in the placement of pediatric access points is the technique of choice due to its superiority in safety and success compared to traditional methods. The integration of detailed guidelines, ongoing clinical training, and the use of advanced techniques such as contrast-enhanced ultrasound optimize outcomes and minimize complications. The inclusion of these skills in the training of specialists in intensive care, emergency medicine, and pediatric surgery is recommended to standardize and improve the quality of care.

Resumen:  El acceso vascular es fundamental en pacientes pediátricos críticos para la administración de tratamientos vitales, monitoreo y toma de muestras sanguíneas. La colocación tradicional de accesos venosos y arteriales basada en referencias anatómicas se asocia a complicaciones por su realización a ciegas. La ecografía a pie de cama ha revolucionado la práctica, permitiendo la visualización en tiempo real del vaso y la aguja, aumentando la tasa de éxito y disminuyendo complicaciones.
Se presenta una guía estandarizada para la colocación de accesos vasculares que incluye evaluación previa, preparación del equipo, posicionamiento del operador y vaso a utilizar,
punción ecoguiada, colocación del catéter y verificación posterior al procedimiento. Se incorporan las modalidades de acceso más frecuentes (vena yugular interna, subclavia y
femoral), situaciones no habituales, catéteres arteriales, detección precoz de complicaciones y posición final del extremo distal del catéter, mejorando esto la seguridad y eficacia y disminuyendo la necesidad de exposición a radiación. Además, se resalta la importancia de la capacitación basada en simulación y la estandarización del procedimiento para preservar la seguridad y eficacia.
La utilización de la ecografía en la colocación de accesos pediátricos es la técnica de elección por su superioridad en seguridad y éxito en comparación con métodos tradicionales.
La integración de guías detalladas, la capacitación clínica continua y el uso de técnicas avanzadas como el ultrasonido con contraste optimizan los resultados y minimizan complicaciones. Se recomienda la inclusión de estas destrezas en la formación de especialistas en cuidados intensivos, emergencias y cirugía pediátrica para estandarizar y mejorar la calidad
del cuidado.

Ultrasonography, Central Venous Catheters, Pediatric Intensive Care, Patient Safety. Source: MeSH.

Javier Ponce.
Hospital Dr. Guillermo Rawson, San Juan, Argentina. Miembro fundador USPed Latinoamérica.

Edgar Ramón Chávez Robles.
Hospital del Niño Morelense, Emiliano Zapata, México. Miembro fundador USPed Latinoamérica.

María Cecilia Garcia.
Hospital de Pediatría J. P. Garrahan. Miembro fundador USPed Latinoamérica.

Daniela Patricia Vallejos Vidal.
Hospital general de niños “Pedro de Elizalde”. Miembro fundador USPed Latinoamérica.

Luis Fernando Sabajan Gómez.
Instituto Guatemalteco de Seguridad Social, Guatemala.

Kasey Fuentes Bernal.
Hospital del Niño Dr. José Renán Esquivel, Panamá.

Lellis Figueroa.
Hospital Dr. Guillermo Rawson, San Juan, Argentina. Miembro fundador USPed Latinoamérica.

Alfredo Carlos Rodríguez-Portelles.
Hospital Metropolitano, Quito, Ecuador. Miembro fundador USPed Latinoamérica.

David Pascual Rojas
Flores.
Hospital General Regional No. 1 del Instituto Mexicano del Seguro Social, Querétaro. Miembro fundador USPed Latinoamérica. 

Rielka Marietta Miranda Isaguirre.
Hospital Victoria Motta, Jinotega, Nicaragua.

  1. Ares G, Hunter CJ. Central venous access in children: indications, devices, and risks. Curr Opin Pediatr. 2017;29:340–6. doi:10.1097/MOP.0000000000000485.
  2. Clark EG, Barsuk JH. Temporary hemodialysis catheters: recent advances. Kidney Int. 2014;86:888–95. doi:10.1038/ki.2014.162.
  3. De Souza TH, Brandão MB, Nadal JAH, Nogueira RJN. Ultrasound guidance for pediatric central venous catheterization: a meta-analysis. Pediatrics. 2018;142:e20181719. doi:10.1542/peds.2018-1719.
  4. Leibowitz A, Oren-Grinberg A, Matyal R. Ultrasound guidance for central venous access: current evidence and clinical recommendations. J Intensive Care Med. 2020;35:303–21. doi:10.1177/0885066619868164.
  5. Matsushima K, Frankel HL. Detection of central venous catheter insertion-related complication using bedside ultrasound: the CVC sono. J Trauma. 2011;70:1561–3. doi:10.1097/TA.0b013e3182128546.
  6. Mitchell EO, Jones P, Snelling PJ. Ultrasound for pediatric peripheral intravenous catheter insertion: a systematic review. Pediatrics. 2022;149. doi:10.1542/peds.2021-055523.
  7. Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, et al. International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care. 2020;24:65. doi:10.1186/s13054-020-2787-9.
  8. Safety Committee of Japanese Society of Anesthesiologists. Practical guide for safe central venous catheterization and management 2017. J Anesth. 2020;34:167–86. doi:10.1007/s00540-019-02702-9.
  9. NSW Agency for Clinical Innovation. Central venous access devices (CVAD). Clinical practice guide. Sydney; 2021.
  10. Piton G, Capellier G, Winiszewski H. Ultrasound-guided vessel puncture: calling for Pythagoras’ help. Crit Care. 2018;22:292. doi:10.1186/s13054-018-2228-1.
  11. Zito Marinosci G, Biasucci DG, Barone G, D’Andrea V, Elisei D, Iacobone E, et al. ECHOTIP-Ped: a structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients. J Vasc Access. 2023;24:5–13. doi:10.1177/11297298211031391.
  12. Yang EJ, Ha HS, Kong YH, Kim SJ. Ultrasound-guided internal jugular vein catheterization in critically ill pediatric patients. Korean J Pediatr. 2015;58:136–41. doi:10.3345/kjp.2015.58.4.136.
  13. Practice guidelines for central venous access 2020: an updated report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2020;132:8–43. doi:10.1097/ALN.0000000000002864.
  14. Pittiruti M, Annetta MG, D’Andrea V. Point-of-care ultrasound for vascular access in neonates and children. Eur J Pediatr. 2024;183:1073–8. doi:10.1007/s00431-023-05378-2.
  15. Shen P, Yu J, Zhu F, Lyu J, Zhao H. Optimizing ultrasound methods for determining central venous catheter tip position. J Emerg Med. 2025;74:103–11. doi:10.1016/j.jemermed.2025.02.020.
  16. Kamalipour H, Ahmadi S, Kamali K, Moaref A, Shafa M, Kamalipour P. Ultrasound for localization of central venous catheter: a good alternative to chest X-ray? Anesth Pain Med. 2016;6:e38834. doi:10.5812/aapm.38834.
  17. Matsushima K, Frankel HL. Detection of central venous catheter insertion-related complication using bedside ultrasound: the CVC sono. J Trauma. 2011;70:1561–3. doi:10.1097/TA.0b013e3182128546.
  18. Neto EPS, Grousson S, Duflo F, Tahon F, Mottolese C, Dailler F. Ultrasonographic anatomic variations of the major veins in paediatric patients. Br J Anaesth. 2014;112:879–84. doi:10.1093/bja/aet482.
  19. Shan Y, Huang W. Anatomical variation in the internal jugular vein: potential risk factors for central venous catheterization—a case report. World J Emerg Med. 2024;15:316–8. doi:10.5847/wjem.j.1920-8642.2024.056.
  20. Oulego-Erroz I, Alonso-Quintela P, Domínguez P, Rodríguez-Blanco S, Muñíz-Fontán M, Muñoz-Lozón A, et al. Ultrasound-guided cannulation of the brachiocephalic vein in neonates and infants. An Pediatr (Engl Ed). 2016;84:331–6. doi:10.1016/j.anpede.2015.10.007.
  21. Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig P-LJ, Easley KA, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med. 2009;37:1090–6. doi:10.1097/CCM.0b013e31819b570e.
  22. Jijeh AMZ, Shaath G, Kabbani MS, Elbarbary M, Ismail S. Ultrasound-guided vascular access in pediatric cardiac critical care. J Saudi Heart Assoc. 2014;26:199–203. doi:10.1016/j.jsha.2014.04.003.
  23. Piton G, Capellier G, Winiszewski H. Ultrasound-guided vessel puncture: calling for Pythagoras’ help. Crit Care. 2018;22. doi:10.1186/s13054-018-2228-1.
  24. López Álvarez JM, Pérez Quevedo O, Santana Cabrera L, Escot CR, Loro Ferrer JF, Lorenzo TR, et al. Vascular ultrasound in pediatrics: estimation of depth and diameter of jugular and femoral vessels. J Ultrasound. 2017;20:285–92. doi:10.1007/s40477-017-0272-3.
  25. Shostak E, Tzeitlin Y, Shochat T, Dagan O, Schiller O. Bedside durable tunneled femoral central venous catheter is feasible and safe in high-risk infants in the pediatric cardiac intensive care unit. J Intensive Care Med. 2023;38:307–12. doi:10.1177/08850666221123899.
  26. Yu K-P, Wang T-C, Kung Y-C, Cheng K-H. Ultrasound-guided venous catheter placement in prone position. J Intensive Care Med. 2025;40:94–108. doi:10.1177/08850666241298224.
  27. Poulsen E, Aagaard R, Bisgaard J, Sørensen HT, Juhl-Olsen P. The effects of ultrasound guidance on first-attempt success for difficult peripheral intravenous catheterization: a systematic review and meta-analysis. Eur J Emerg Med. 2023;30:70–7. doi:10.1097/MEJ.0000000000000993.
  28. Yang MX, Ng PK. Central venous catheter insertion in the prone position—a last resort in critically ill COVID-19 patients. J Intensive Care Med. 2021;36:373–5. doi:10.1177/0885066620959649.
  29. Kleidon TM, Schults JA, Royle RH, Gibson V, Ware RS, Andresen E, et al. First-attempt success in ultrasound-guided vs standard peripheral intravenous catheter insertion: the EPIC superiority randomized clinical trial. JAMA Pediatr. 2025;179:255–63. doi:10.1001/jamapediatrics.2024.5581.
  30. Kleidon TM, Schults J, Rickard CM, Ullman AJ. Techniques and technologies to improve peripheral intravenous catheter outcomes in pediatric patients: systematic review and meta-analysis. J Hosp Med. 2021;16:742–50. doi:10.12788/jhm.3718.
  31. Stolz LA, Cappa AR, Minckler MR, Stolz U, Wyatt RG, Binger CW, et al. Prospective evaluation of the learning curve for ultrasound-guided peripheral intravenous catheter placement. J Vasc Access. 2016;17:366–70. doi:10.5301/jva.5000574.
  32. Brescia F, Pittiruti M, Spencer TR, Dawson RB. The SIP protocol update: eight strategies, incorporating rapid peripheral vein assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access. 2024;25:5–13. doi:10.1177/11297298221099838.
  33. Dawson RB. PICC zone insertion method™ (ZIM™): a systematic approach to determine the ideal insertion site for PICCs in the upper arm. J Assoc Vasc Access. 2011;16:156–65. doi:10.2309/java.16-3-5.
  34. Lau CSM, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016;80:178–84. doi:10.1038/pr.2016.74.
  35. Breschan C, Platzer M, Jost R, Stettner H, Feigl G, Likar R. Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in infants: a retrospective analysis of a case series. Paediatr Anaesth. 2012;22:1062–7. doi:10.1111/j.1460-9592.2012.03923.x.
  36. Acosta CM, Tusman G. Ultrasound-guided brachiocephalic vein access in neonates and pediatric patients. Rev Esp Anestesiol Reanim (Engl Ed). 2021;68:584–91. doi:10.1016/j.redare.2020.10.011.
  37. Shi L, Chen Q, Yang R, Liao L, Zhang J, Liu Y. Challenges of PICC placement via the popliteal vein under ultrasound guidance in a patient with severe burns: a case report. J Vasc Access. 2025;26:1046–50. doi:10.1177/11297298241245066.
  38. Boe BA, Zampi JD, Yu S, Donohue JE, Aiyagari R. Transhepatic central venous catheters in pediatric patients with congenital heart disease. Pediatr Crit Care Med. 2015;16:726–32. doi:10.1097/PCC.0000000000000484.
  39. Mortell A, Said H, Doodnath R, Walsh K, Corbally M. Transhepatic central venous catheter for long-term access in paediatric patients. J Pediatr Surg. 2008;43:344–7. doi:10.1016/j.jpedsurg.2007.10.044.
  40. Machata A-M, Marhofer P, Breschan C. Ultrasound-guided central venous access in infants and children. Tren Anaesth Crit Care. 2013;3:188–92. doi:10.1016/j.tacc.2013.03.008.
  41. Takeshita J, Nakayama Y, Tachibana K, Nakajima Y, Hamaba H, Shime N. Comparison of radial, dorsalis pedis, and posterior tibial arteries for ultrasound-guided arterial catheterisation with dynamic needle tip positioning in paediatric patients: a randomised controlled trial. Br J Anaesth. 2023;131:739–44. doi:10.1016/j.bja.2023.07.022.
  42. Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS, et al. Use of point-of-care ultrasonography in the NICU for diagnostic and procedural purposes. Pediatrics. 2022;150. doi:10.1542/peds.2022-060053.
  43. Starke RM, Snelling B, Al-Mufti F, Gandhi CD, Lee S-K, Dabus G, et al. Transarterial and transvenous access for neurointerventional surgery: report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg. 2020;12:733–41. doi:10.1136/neurintsurg-2019-015573.
[1] Javier Ponce, Edgar Ramón Chávez Robles, María Cecilia Garcia, Daniela Patricia Vallejos Vidal, Luis Fernando Sabajan Gómez, Kasey Fuentes Bernal, Lellis Figueroa, Alfredo Carlos Rodríguez-Portelles, David Pascual Rojas Flores, and Rielka Marietta Miranda Isaguirre. 2026. Guía práctica para la colocación ecográfica de accesos venosos y arteriales en pediatría: recomendaciones GAVA. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 1–17. https://doi.org/10.58281/ccem060126-rev-nar-10

Video 1. Vena trombosada (A) y vena sin trombosis (B y C).

Video 2. Punción en simulador. A. Punción en plano. B. Punción fuera de plano sobre simulador.

Video 3. Guía metálica intravascular.

Video 4. Ecografía contrastada (CEUS) en cavidades derechas para evaluar la localización de la punta del catéter.

 

Video 5. Ejemplo de colocación de catéter venoso central yugular izquierdo posterior ecoguiado en decúbito prono en paciente bajo ventilación de alta frecuencia con catéter venoso
central (CVC) yugular derecho previo disfuncional. B.

 

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2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

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Patrocinadores

www.doi.org/10.58281/ccem060126-rev-nar-10

Javier Ponce 1 , Edgar Ramón Chávez Robles 2 , María Cecilia Garcia 3 , Daniela Patricia Vallejos Vidal 4 , Luis Fernando Sabajan Gómez 5 , Kasey Fuentes Bernal 6 , Lellis Figueroa 1 , Alfredo Carlos Rodríguez-Portelles 7 , David Pascual Rojas Flores 8 , Rielka Marietta Miranda Isaguirre 9 .

1 Hospital Dr. Guillermo Rawson, San Juan, Argentina. Miembro fundador USPed Latinoamérica.
2 Hospital del Niño Morelense, Emiliano Zapata, México. Miembro fundador USPed Latinoamérica.
3 Hospital de Pediatría J. P. Garrahan. Miembro fundador USPed Latinoamérica.
4 Hospital general de niños “Pedro de Elizalde”. Miembro fundador USPed Latinoamérica.
5 Instituto Guatemalteco de Seguridad Social, Guatemala.
6 Hospital del Niño Dr. José Renán Esquivel, Panamá.
7 Hospital Metropolitano, Quito, Ecuador. Miembro fundador USPed Latinoamérica.
8 Hospital General Regional No. 1 del Instituto Mexicano del Seguro Social, Querétaro. Miembro fundador USPed Latinoamérica.
9 Hospital Victoria Motta, Jinotega, Nicaragua.

Editor
Manuel Alberto Guerrero Gutierrez , Lizeth Tapia .

Chair
Diego Escarraman Martinez .

Abstract

Abstract: Vascular access is essential in critically ill pediatric patients for the administration of life-saving treatments, monitoring, and blood sampling. Traditional placement of venous and arterial access based on anatomical landmarks is associated with complications due to its blind execution. Bedside ultrasound has revolutionized the practice, allowing real-time visualization of the vessel and needle, increasing success rates, and reducing complications. A standardized guide is presented
for vascular access placement, which includes prior evaluation, equipment preparation, positioning of the operator and the vessel to be used, ultrasound-guided puncture, catheter placement, and post-procedure verification.
The most common access modalities (internal jugular vein, subclavian, and femoral), unusual situations, arterial catheters, early detection of complications, and the final position of the catheter’s distal tip are included, there by improving safety and effectiveness, and reducing the need for radiation exposure. Additionally, the importance of simulation-based training and standardization of the procedure to maintain safety and effectiveness is emphasized.

The use of ultrasound in the placement of pediatric access points is the technique of choice due to its superiority in safety and success compared to traditional methods. The integration of detailed guidelines, ongoing clinical training, and the use of advanced techniques such as contrast-enhanced ultrasound optimize outcomes and minimize complications. The inclusion of these skills in the training of specialists in intensive care, emergency medicine, and pediatric surgery is recommended to standardize and improve the quality of care.

Resumen:  El acceso vascular es fundamental en pacientes pediátricos críticos para la administración de tratamientos vitales, monitoreo y toma de muestras sanguíneas. La colocación tradicional de accesos venosos y arteriales basada en referencias anatómicas se asocia a complicaciones por su realización a ciegas. La ecografía a pie de cama ha revolucionado la práctica, permitiendo la visualización en tiempo real del vaso y la aguja, aumentando la tasa de éxito y disminuyendo complicaciones.
Se presenta una guía estandarizada para la colocación de accesos vasculares que incluye evaluación previa, preparación del equipo, posicionamiento del operador y vaso a utilizar,
punción ecoguiada, colocación del catéter y verificación posterior al procedimiento. Se incorporan las modalidades de acceso más frecuentes (vena yugular interna, subclavia y
femoral), situaciones no habituales, catéteres arteriales, detección precoz de complicaciones y posición final del extremo distal del catéter, mejorando esto la seguridad y eficacia y disminuyendo la necesidad de exposición a radiación. Además, se resalta la importancia de la capacitación basada en simulación y la estandarización del procedimiento para preservar la seguridad y eficacia.
La utilización de la ecografía en la colocación de accesos pediátricos es la técnica de elección por su superioridad en seguridad y éxito en comparación con métodos tradicionales.
La integración de guías detalladas, la capacitación clínica continua y el uso de técnicas avanzadas como el ultrasonido con contraste optimizan los resultados y minimizan complicaciones. Se recomienda la inclusión de estas destrezas en la formación de especialistas en cuidados intensivos, emergencias y cirugía pediátrica para estandarizar y mejorar la calidad
del cuidado.

Ultrasonography, Central Venous Catheters, Pediatric Intensive Care, Patient Safety. Source: MeSH.

Javier Ponce.
Hospital Dr. Guillermo Rawson, San Juan, Argentina. Miembro fundador USPed Latinoamérica.

Edgar Ramón Chávez Robles.
Hospital del Niño Morelense, Emiliano Zapata, México. Miembro fundador USPed Latinoamérica.

María Cecilia Garcia.
Hospital de Pediatría J. P. Garrahan. Miembro fundador USPed Latinoamérica.

Daniela Patricia Vallejos Vidal.
Hospital general de niños “Pedro de Elizalde”. Miembro fundador USPed Latinoamérica.

Luis Fernando Sabajan Gómez.
Instituto Guatemalteco de Seguridad Social, Guatemala.

Kasey Fuentes Bernal.
Hospital del Niño Dr. José Renán Esquivel, Panamá.

Lellis Figueroa.
Hospital Dr. Guillermo Rawson, San Juan, Argentina. Miembro fundador USPed Latinoamérica.

Alfredo Carlos Rodríguez-Portelles.
Hospital Metropolitano, Quito, Ecuador. Miembro fundador USPed Latinoamérica.

David Pascual Rojas
Flores.
Hospital General Regional No. 1 del Instituto Mexicano del Seguro Social, Querétaro. Miembro fundador USPed Latinoamérica. 

Rielka Marietta Miranda Isaguirre.
Hospital Victoria Motta, Jinotega, Nicaragua.

  1. Ares G, Hunter CJ. Central venous access in children: indications, devices, and risks. Curr Opin Pediatr. 2017;29:340–6. doi:10.1097/MOP.0000000000000485.
  2. Clark EG, Barsuk JH. Temporary hemodialysis catheters: recent advances. Kidney Int. 2014;86:888–95. doi:10.1038/ki.2014.162.
  3. De Souza TH, Brandão MB, Nadal JAH, Nogueira RJN. Ultrasound guidance for pediatric central venous catheterization: a meta-analysis. Pediatrics. 2018;142:e20181719. doi:10.1542/peds.2018-1719.
  4. Leibowitz A, Oren-Grinberg A, Matyal R. Ultrasound guidance for central venous access: current evidence and clinical recommendations. J Intensive Care Med. 2020;35:303–21. doi:10.1177/0885066619868164.
  5. Matsushima K, Frankel HL. Detection of central venous catheter insertion-related complication using bedside ultrasound: the CVC sono. J Trauma. 2011;70:1561–3. doi:10.1097/TA.0b013e3182128546.
  6. Mitchell EO, Jones P, Snelling PJ. Ultrasound for pediatric peripheral intravenous catheter insertion: a systematic review. Pediatrics. 2022;149. doi:10.1542/peds.2021-055523.
  7. Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, et al. International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care. 2020;24:65. doi:10.1186/s13054-020-2787-9.
  8. Safety Committee of Japanese Society of Anesthesiologists. Practical guide for safe central venous catheterization and management 2017. J Anesth. 2020;34:167–86. doi:10.1007/s00540-019-02702-9.
  9. NSW Agency for Clinical Innovation. Central venous access devices (CVAD). Clinical practice guide. Sydney; 2021.
  10. Piton G, Capellier G, Winiszewski H. Ultrasound-guided vessel puncture: calling for Pythagoras’ help. Crit Care. 2018;22:292. doi:10.1186/s13054-018-2228-1.
  11. Zito Marinosci G, Biasucci DG, Barone G, D’Andrea V, Elisei D, Iacobone E, et al. ECHOTIP-Ped: a structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients. J Vasc Access. 2023;24:5–13. doi:10.1177/11297298211031391.
  12. Yang EJ, Ha HS, Kong YH, Kim SJ. Ultrasound-guided internal jugular vein catheterization in critically ill pediatric patients. Korean J Pediatr. 2015;58:136–41. doi:10.3345/kjp.2015.58.4.136.
  13. Practice guidelines for central venous access 2020: an updated report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2020;132:8–43. doi:10.1097/ALN.0000000000002864.
  14. Pittiruti M, Annetta MG, D’Andrea V. Point-of-care ultrasound for vascular access in neonates and children. Eur J Pediatr. 2024;183:1073–8. doi:10.1007/s00431-023-05378-2.
  15. Shen P, Yu J, Zhu F, Lyu J, Zhao H. Optimizing ultrasound methods for determining central venous catheter tip position. J Emerg Med. 2025;74:103–11. doi:10.1016/j.jemermed.2025.02.020.
  16. Kamalipour H, Ahmadi S, Kamali K, Moaref A, Shafa M, Kamalipour P. Ultrasound for localization of central venous catheter: a good alternative to chest X-ray? Anesth Pain Med. 2016;6:e38834. doi:10.5812/aapm.38834.
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[1] Javier Ponce, Edgar Ramón Chávez Robles, María Cecilia Garcia, Daniela Patricia Vallejos Vidal, Luis Fernando Sabajan Gómez, Kasey Fuentes Bernal, Lellis Figueroa, Alfredo Carlos Rodríguez-Portelles, David Pascual Rojas Flores, and Rielka Marietta Miranda Isaguirre. 2026. Guía práctica para la colocación ecográfica de accesos venosos y arteriales en pediatría: recomendaciones GAVA. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 1–17. https://doi.org/10.58281/ccem060126-rev-nar-10

Video 1. Vena trombosada (A) y vena sin trombosis (B y C).

Video 2. Punción en simulador. A. Punción en plano. B. Punción fuera de plano sobre simulador.

Video 3. Guía metálica intravascular.

Video 4. Ecografía contrastada (CEUS) en cavidades derechas para evaluar la localización de la punta del catéter.

 

Video 5. Ejemplo de colocación de catéter venoso central yugular izquierdo posterior ecoguiado en decúbito prono en paciente bajo ventilación de alta frecuencia con catéter venoso
central (CVC) yugular derecho previo disfuncional. B.

 

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DOI: 10.3989/ccem

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