Peripherally inserted central catheters (PICC) are frequently placed by a member of a nurse PICC team (Krein 2019). PICC team members complete additional training in ultrasound technique and relevant anatomy and physiology.
The nurse placing the PICC will carry out the medical order using his/her professional judgment to select the best insertion site based upon patient history and anatomy. Nurses identify insertion sites using visualization, palpation and ultrasound. Ultrasound-guided insertion can minimize the physical and emotional trauma of multiple failed attempts through visual confirmation of vein adequacy and catheter placement.
Upper extremity insertion site
"Right-arm access through the basilic or brachial vein may be more appropriate for successful nonfluoroscopic PICC insertion compared with the access through the left arm and the cephalic vein" (Jeon E., et al 2018).
Use the interactive graphic PICC A Vein to trace bloodflow from, basilic v. ➤ axillary v. ➤ subclavian v. ➤ Brachiocephalic veins ➤ superior vena cava ️♥ right atriumVessel selection in order of preference:
The basilic vein is relatively superficial and has the largest diameter and the greatest blood flow of the peripheral arm veins. The right basilic vein also offers the straightest blood return path to the right atrium (Gonzalez 2020).
The median cubital vein has a small diameter and a variable course but it may offer the second best insertion choice for smaller catheters. This is because it often takes a direct path to the the basilic vein and then on to the SVC.
The cephalic vein may be the third best insertion choice because it often narrows along its path and may form an angle where it joins the axillary vein. Both of these issues increase the risk of insertion related mechanical phlebitis.
Brachial insertion has a higher risk of injury. The brachial veins are located deep in soft tissue, adjacent to the brachial artery and close to the median nerve. Insertion may require ultrasound or fluoroscopic guidance to protect adjacent structures (Gonzalez 2020). The steep angle necessary to access the vein can predispose to catheter kinking.
PICC line insertion can be performed as an inpatient or outpatient procedure. Regardless of setting, maximum barrier precautions and aseptic technique are essential throughout the procedure. The nurse placing the PICC will use his/her professional judgment to select the best placement site based upon patient history and anatomy. Nurses identify insertion sites using visualization, palpation and ultrasound assisted insertion is becoming common. Ultrasound-guided insertion can minimize the physical and emotional trauma of multiple attempts through visual confirmation of vein adequacy and catheter placement.
Regardless of vein selection, the ideal point of insertion will be above the antecubital space in order to minimize the mechanical problems associated with arm bending.
The optimum vein for the insertion of a PICC catheter is the :
References
Jeon E.Y., Cho Y.K., Yoon D.Y., Hwang J.H. 2016. Which arm and vein are more appropriate for single-step, non-fluoroscopic, peripherally inserted central catheter insertion? J Vasc Access. 2016 May 7;17(3):249-55
Gonzalez R, Cassaro S. Percutaneous Central Catheter. [Updated 2020 Sep 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459338/
Krein, S. L., Kuhn, L., Ratz, D., Chopra, V. 2019. Use of Designated Nurse PICC Teams and CLABSI Prevention Practices Among U.S. Hospitals: A Survey-Based Study, Journal of Patient Safety: Volume 15 - Issue 4 - p 293-295.
© RnCeus.com