Which arm and vein are more appropriate for single-step, non-fluoroscopic, peripherally inserted central catheter...

Area of Science:

• Vascular Access
• Medical Device Insertion
• Interventional Radiology

Background:

• Peripherally inserted central catheters (PICCs) are crucial for long-term venous access.
• Non-fluoroscopic methods aim to reduce radiation exposure during PICC insertion.
• Optimizing insertion site selection is key to improving procedural success and patient safety.

Purpose of the Study:

• To determine the optimal arm and vein for successful non-fluoroscopic PICC insertion.
• To analyze factors influencing PICC insertion success and failure rates.

Main Methods:

• Retrospective review of 743 non-fluoroscopic PICC insertions.
• Analysis of accessed arm (right/left) and vein (cephalic, basilic, brachial).
• Evaluation of primary/secondary success rates, failure causes, and problem-solving techniques.

Main Results:

• The left cephalic vein showed a significantly higher failure rate compared to other veins.
• Obstacles were most commonly located in the subclavian, axillary, and brachiocephalic veins.
• Guidewire assistance was the primary method for catheter repositioning.

Conclusions:

• Right-arm access, particularly through the basilic or brachial vein, is recommended for non-fluoroscopic PICC insertion.
• Avoiding the left cephalic vein may reduce insertion failures.
• Understanding common failure points aids in developing effective problem-solving strategies.