All PICC
Prepare the equipment
- Use a linear-array transducer.
- Select the venous examination setting.
- Follow appropriate sterile technique according to institutional policy.
Position the patient
- Place the patient supine.
- Extend the arm 90° at the patient’s side.
- Externally rotate the arm.
Place the transducer
- Position the transducer transversely on the medial upper arm.
- Place it superior to the antecubital fossa and inferior to the axilla.
- Direct the orientation marker toward the patient’s right.
Identify the target vein
- Locate the basilic vein as a superficial, anechoic, circular, compressible structure.
- The basilic vein should lie medial and superficial to the brachial vein and artery.
- Identify the humerus deeper in the image as a hyperechoic structure.
Center the basilic vein
- Adjust the transducer until the basilic vein is centered within the ultrasound image.
- Confirm venous compressibility and distinguish the vein from the adjacent artery.
Begin needle insertion
- Position the needle just superior to the transducer.
- Slowly advance the needle adjacent to the transducer’s center line.
- The needle should appear as a small, bright dot in the ultrasound image.
Use the short-axis, dynamic needle-tip technique
- When the needle tip becomes visible, slide the transducer a short distance away until the tip disappears.
- Slowly advance the needle until the tip reappears.
- Repeat this process to ensure that the needle tip remains under direct ultrasound guidance.
Puncture the vein
- Continue advancing slowly until the needle tip is seen indenting and then puncturing the basilic vein.
Confirm needle position
- Rotate the transducer 90° to obtain an in-plane, longitudinal view.
- Confirm that the needle tip lies within the midportion of the basilic vein lumen.
Recognize alternative access veins
- The same ultrasound-guided technique may be used to access the deep brachial or cephalic veins.
Proceed according to institutional protocol
- Complete PICC advancement, tip-position confirmation, securing, and post-procedure care according to approved local guidelines.
