Veins of the Upper Extremities Used for Vascular Access PDF

## Veins of the Upper Extremities Used for Vascular Access ### Cephalic Vein - **Anatomic Route**: Superficial vein that arises from the dorsal radial side of the wrist (thumb side), and continues up to the antecubital fossa. Above the elbow it ascends superficially along the lateral border of the...

## Veins of the Upper Extremities Used for Vascular Access ### Cephalic Vein - **Anatomic Route**: Superficial vein that arises from the dorsal radial side of the wrist (thumb side), and continues up to the antecubital fossa. Above the elbow it ascends superficially along the lateral border of the biceps muscle and the pectoral border of the deltoid muscle, and merges into the axillary vein. Occasionally connected with the EJ or Subclavian vein by a branch that passes upward in front of the clavicle. - **Clinical Considerations**: - Smaller than the basilic vein and often smaller than the brachial veins. - Often narrows as it ascends upper extremity. - Often makes a sharp turn as it enters axillary vein, causing difficulty with advancement of PICC and increases the risk of thrombosis formation due to this narrowing. May be vein of choice in extremely obese patients. - Higher risk of mechanical phlebitis with placement of PICC in cephalic vein. - Ultrasound can assess the size of cephalic vein along the route going up the arm for accuracy with PICC placement and CVR assessment. ### Basilic Vein - **Anatomic Route**: Superficial vein that originates from the ulnar medial aspect of the venous network which drains the hand and lower arm. Basilic vein continues up the medial side of the arm, across the antecubital fossa, traversing up the medial side of the upper arm terminating where it joins the brachial veins to become the axillary vein. Above the antecubital fossa, the basilic vein travels deeper under the muscles but is still classified as a superficial vein. - **Clinical Considerations**: - Large vein in the upper arm. - Vein of choice for the placement of PICC or midline catheter. - Smooth, direct route into the axillary vein and central circulation. - Use Ultrasound guidance to place PICC above the antecubital fossa, decreasing risk of mechanical phlebitis and/or thrombosis. ### Median Vein - **Anatomic Route**: - **Median**: Distal to the antecubital fossa. - **Median Cubital**: Superficial vein, may be palpated and visualized in the antecubital fossa. Vein joins either cephalic or basilic vein. - **Clinical Considerations**: - Frontal (flat) aspect of the forearm. - Preferred area for PIV. - Significant variation of the presentation and route. - Often used for venipuncture, but not for PICC placement. ### Brachial Vein - **Anatomic Route**: Usually appear as a pair of veins that drain the deep venous system of the lower arm. Originate in the antecubital fossa, traverse up the middle of the arm along with the brachial artery (which travels in the opposite direction). The basilic and brachial veins join to form the axillary vein. Classified as a deep vein. - **Clinical Considerations**: - Requires use of ultrasound guidance. - Runs along inner upper arm, bundled with brachial artery and median nerve. - **Pediatric Considerations**: Use caution with use of brachial vein for PICC Insertion in young or nonverbal patients due to their inability to verbalize symptoms of nerve injury which includes pain and/or numbness. ### Axillary Vein - **Anatomic Route**: Begins at the junction of the basilic and brachial veins, traverses through the shoulder and terminates at the lateral border of the first rib. Continues to the subclavian vein. Classified as a deep vein. - **Clinical Considerations**: - Should be used as an alternative to subclavian site for CVAD Insertion due to its ease of access on the upper chest when using ultrasound guidance; reduces risk of pneumothorax or arterial puncture. - These veins should NOT be used for CVAD insertion in patients with CKD or ESRD. ### External Jugular (EJ) Vein - **Anatomic Route**: Superficial vein that originates near the angle of the mandible, and courses over the sternocleidomastoid muscle. Proximal to the clavicle, the EJ dives into the subcutaneous tissue, eventually emptying into the subclavian vein. - **Clinical Considerations**: - Easy to access because it is superficial; acceptable for emergent and very short-term IV access. - Tortuous course and much smaller diameter when compared with internal jugular vein; routine CVAD insertion is not recommended in this vein. - The EJ is often engorged in patients with heart failure and provides an alternative If other venous access sites are not immediately available. - Risk is thrombosis and extravasation.