![]() An axial view of the vessel with the ultrasound will allow visualization of the needle tip. ![]() Ultrasound will confirm the correct positioning of the needle within the vein, as will blood return from the needle. Using the access needle, puncture the vein while directly visualizing the needle tip. Sedation may be given for the procedure.ĭirectly visualize the access vein with ultrasound and anesthetize the skin and subcutaneous tissue over the area of the vein with 1% lidocaine. Flush all catheter lumens with normal saline and clamp them shut. Ensure items are in the center of the sterile field. Ensure supplies are arranged in a sterile and organized fashion for easy access. Place the sterile cover over the ultrasound probe. Appropriately drape the patient with sterile draping material. Prep the area with an antiseptic solution. This will be the approximate measurement of the catheter. With the measuring tape, measure the distance from the antecubital fossa to the midclavicular line and turn the tape measure to reach the third intercostal space at the right border of the sternum. Use ultrasound to identify and select the appropriate vessel for access. Place the patient in a supine position with the arm abducted and externally rotated. Connect the patient to a cardiac monitor to detect arrhythmias that may occur as a result of wire access into the right atrium. If the venous system of the right upper extremity is not accessible due to superficial infection, trauma, or obstruction, a left-sided approach may be attempted.ĭiscuss the procedural risks and benefits with the patient. Alternatively, the cephalic vein may be used for access. There is a higher risk of inadvertent arterial puncture with this venous access location with the brachial artery nearby. If the basilic vein is not accessible or occluded, an attempt at accessing the right brachial vein may be attempted. It is thought that this vein also has the least number of valves and provides a more optimal access angle. A right basilic venotomy location provides the least tortuous path toward the superior vena cava. The right and left innominate veins to combine at the superior vena cava. ![]() After combining with the brachial vein, the axillary vein is formed, which becomes the subclavian vein at the border of the first rib and continues centrally to become the brachiocephalic (innominate) vein. Originating from the dorsal venous network of the hand, the basilic vein travels on the medial aspect of the upper extremity. The basilic vein is usually accessed between the axilla and the antecubital fossa. You have any concerns about your catheter.The right basilic vein’s size and proximity to the skin make it the attempted vein of choice for PICC placement.Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: You have chest pain or shortness of breath.This may happen after severe coughing or vomiting, or if you pull on the catheter. You feel resistance when you inject medicine or fluids into your catheter.If you have bleeding or leaking that is heavy enough to soak through the dressing, put firm pressure on the PICC where it goes into your skin.Your catheter is leaking, cracked, or clogged.You have signs of a blood clot, such as bulging veins near the catheter.You have swelling in your face, chest, neck, or arm on the side where the catheter is.Increased pain, swelling, warmth, or redness.You have sudden chest pain and shortness of breath, or you cough up blood.Ĭall your doctor or nurse advice line now or seek immediate medical care if:.When you shower, cover the area with waterproof material, such as plastic wrap.Ĭall 911 anytime you think you may need emergency care. To help prevent infection, take a shower instead of a bath.Call your healthcare provider right away. Tape the PICC to your skin and cover it with a sterile dressing, if you can. If your PICC gets broken or torn, fold it over between the damaged area and where it goes into your skin.Fasten or tape the catheter to your body to prevent pulling or dangling.If your catheter has a clamp, keep it clamped when you are not using it.Never use scissors, knives, pins, or other sharp objects near the catheter or other tubing.Never touch the open end of the catheter if the cap is off.Always wash your hands before you touch your catheter.Avoid clothing that rubs or pulls on your catheter.When getting dressed, be careful not to pull on the catheter. Wear loose clothing over the catheter.
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