Appropriate tourniquet pressure for peripherally inserted central catheter placement in the upper arm

A peripherally inserted central catheter (PICC) placement often requires ultrasound guidance. Previous studies using an adult blood pressure cuff have suggested that veins do not easily collapse at the tourniquet pressure from diastolic to systolic blood pressure. When inserting a PICC into the basilic vein of the upper arm, a narrow blood pressure cuff should be used as a tourniquet to avoid concealing the puncture site. The aim of this study was to determine the appropriate tourniquet pressure using a narrow cuff when inserting a PICC into the upper arm.

We measured the upper arm's blood pressure of seven healthy participants using a pediatric cuff and applied pressure to the upper arm with the pediatric cuff at six levels: 0 mmHg (0), half of the diastolic pressure (D/2), diastolic pressure (D), pressure obtained by combining the systolic and diastolic pressures and dividing by two (DS), systolic pressure (S), and blood pressure as the pulse wave disappears (S + α). An ultrasound probe compressed the basilic vein through the skin. The pressure at which the vein collapsed at each tourniquet pressure was examined.

The venous collapse pressure was higher when the tourniquet pressure was D, DS, or S.

D to S is appropriate for PICC placement in the basilic vein of the upper arm in terms of venous collapse.