title: Snare technique for the placement of a peripherally inserted central catheter in the neonatal and pediatric patient.
abstract: OBJECTIVE
  The placement of a peripherally inserted central catheter (PICC) for neonatal or pediatric patients may at times be technically challenging. We describe an alternate method of placing a PICC in neonatal and pediatric patients with difficult venous access.
  
  
  METHODS
  An Amplatz gooseneck snare is advanced from the femoral vein to the basilic vein, as a target for puncture and guidewire positioning, allowing PICC placement. Between 1999 and 2006, 44 PICCs were placed in the manner described. The medical records were reviewed allowing for up to 7 yrs of patient follow-up.
  
  
  RESULTS
  Ninety-five percent of PICCs were successfully placed using the snare technique. Two placements were aborted and two procedural complications occurred. The review revealed no evidence of osteomyelitis, nerve injury, deep venous thrombosis or leg length discrepancy.
  
  
  CONCLUSIONS
  This technique offers an alternate method for PICC placement in neonatal and pediatric patients when conventional methods are unsuccessful. The technique avoids the need for intermediate to long-term jugular, subclavian or femoral vein access.
authors.affiliation: Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, USA.
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Monsky
authors.forename: Armando S
authors.initials: AS
authors.lastname: Garza
authors.forename: Shaun
authors.initials: S
authors.lastname: Loh
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Link
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002408:Catheters, Indwelling; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency