PURPOSE: To determine if the basilic and cephalic veins are easily accessible for peripheral venous access.
METHODS: 3375 patients were referred for PICC (Peripherally Inserted Central Catheter) placement from October 1, 2001 to March 23, 2004. The operator’s site of choice for access were the basilic and cephalic veins. No patient was excluded because of previous difficulty with venous access. Patients were excluded when uncooperative, have signs or symptoms of venous thrombosis or thrombophlebitis on side of access, local infection, injury to the arm, history of hemophilia and radical mastectomy on side of insertion. The operator performed both the needle insertion and ultrasound guidance procedures.
RESULTS: Successful access is defined as being able to insert a catheter with demonstrable venous return. Of the 3375 patients, the operator was able to access the basilic or cephalic vein on one arm in 3363, a success rate of 99.64%. He was not able to establish access in four(4) patients, had to use the other arm in two(2) and had to use other sites than the basilic/cephalic vein in six(6). Catheters used were angiocath in four(4), triple lumen in thirty-two(32) and PICCs in three thousand three hundred twenty-seven(3327) patients.
CONCLUSION: The basilic and cephalic veins are easily accessible for peripheral venous access procedure especially when performed under ultrasound guidance.
CLINICAL IMPLICATIONS: When traditional peripheral venous access using veins in the lower arms is not successful, the usual practice is to proceed to central venous access using the subclavian or internal jugular veins which has serious complications of pneumothorax and hemothorax. Under ultrasound guidance, the basilic and cephalic veins can be easily used for peripheral venous access, thus eliminating these serious complications. Ultrasound guidance is easy to learn and portable ultrasound machines for vascular access are now available at a reasonable price ($12-15,000). The hospital administration should therefore establish the use of ultrasound guidance for peripheral venous access to minimize patient discomfort and avoid complications associated with central venous access procedures thus decreasing morbidity/mortality.
DISCLOSURE: Eduardo Casalmir, None.