Abstract Background: Image guided inserted central venous cath-eters are used extensively in neonates and children. Aim of Study: This study aimed to evaluate the technical and functional aspects concerning image guided central venous lines in critically ill pediatric patients. Patients and Methods: This prospective study done in-cluded 20 pediatric patients, 10 patients of them underwent peripheral central catheters insertion while, the other 10 patients had traditional central venous lines using ultrasound and/or fluoroscopy guidance for different indications. Results: Venous access devices (VADs) were successfully provided for 20 patients. There were 12 males (60%) and 8 females (40%) with a mean age of 4.91 years (range, 0-15 years). The right internal jugular vein was the main site of entrance for 5 cases (25%); 2 patients coming for bone marrow transplantation BMT & 3 patients on regular hemodialysis. The left internal jugular vein was used for 3 cases (15%); 2 cases on hemodialysis and one case for BMT. The right subclavian vein was used in 4 cases (20%) with end stage renal disease on hemodialysis. The left femoral vein was used for 3 (15%) PICC lines with septic shock and inotropes. The right femoral vein was used for 2 (10%) PICC lines with multisystem organ failure. The right basilic vein was used for 1 PICC line (5%) and the left greater saphenous vein was used in another 2 PICC lines (10%). Conclusion: Image guided vascular venous access tech-nique is considered as a feasible, safe and valuable option in critically ill pediatric patients.