J Korean Med Sci.  2023 Oct;38(41):e329. 10.3346/jkms.2023.38.e329.

Anatomical Structures to Be Concerned With During Peripherally Inserted Central Catheter Procedures

• Kim D
• Park JW
• Cho SB
• Rhyu IJ

• KMID: 2547176
• DOI: http://doi.org/10.3346/jkms.2023.38.e329

Abstract

Background
The central line has been frequently used for drug and nutrition supply and regular blood sampling of patients with chronic diseases. However, this procedure is performed in a highly sensitive area and has several potential complications. Therefore, peripherally inserted central catheters (PICC), which have various advantages, are being extensively used. Although the number of PICC procedures is increasing, the anatomy for safe procedures has not yet been properly established. Therefore, we studied basic anatomical information for safe procedures.
Methods
We used 20 fixed cadavers (40 arms) donated to the Korea University College of Medicine. The mean age was 76.75 years (range, 48–94 years). After dissection of each arm, the distribution pattern of the basilic vein and close structures was recorded, and some important parameters based on bony landmarks were measured. In addition, the number of vein branches (axillary region) and basilic vein diameter were also checked.
Results
The mean length from the insertion site to the right atrium was 38.39 ± 2.63 cm (left) and 34.66 ± 3.60 cm (right), and the basilic vein diameter was 4.93 ± 1.18 mm (left) and 4.08 ± 1.49 mm (right). The data showed significant differences between the left and right arms (P < 0.05). The mean distance from the basilic vein to brachial artery was 8.29 ± 2.78 mm in men and 7.81 ± 2.78 mm in women, while the distance to the ulnar nerve was 5.41 ± 1.67 mm in men and 5.52 ± 2.06 mm in women.
Conclusion
According to these results, the right arm has a shorter distance from the insertion site to the right atrium, and the left arm has a wider vein diameter, which is advantageous for the procedure. In addition, the ulnar nerve and brachial artery were located close to or behind the insertion site. Therefore, special attention is required during the procedure to avoid damaging these important structures.

Keyword

Central Venous Catheters; Catheterization; Peripherally Inserted Central Line (PICC); Basilic Vein; Ulnar Nerve; Brachial Artery

Figure

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  Fig. 1 Vessel and nerve structures in the arm. Total length of the arm (greater tubercle–lateral epicondyle) (↔); Distance from the medial epicondyle to the splitting point of the brachial vein from the basilic vein (<--->); Insertion site (midpoint of total arm length, ▼); Distance from the basilic vein to the brachial artery and the ulnar nerve (◆); Vein branches in the axillary region (★).LE = lateral epicondyle, ME = medial epicondyle, GT = greater tubercle.

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  Fig. 2 Route from the basilic vein in the arm to the right atrium. The yellow line is the inserted PICC, and this length was measured by directly inserting the PICC catheter.PICC = peripherally inserted central catheters.

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  Fig. 3 PICC catheter. (A) Whole catheter kit (Power PICC® Catheter; BARD Access Systems, Inc., Salt Lake City, UT, USA), (B) Dual lumen PICC.PICC = peripherally inserted central catheters.

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  Fig. 4 Dissected arm. Purple (BB) is the biceps brachii muscle, green (TB) is the triceps brachii muscle, yellow (UN) is the ulnar nerve, red (BA) is the brachial artery, blue (BV) is the basilic vein, and MN is median nerve. Based on the basilic vein, the brachial artery is located on the deep lateral side with a mean distance of 8.05 ± 2.43 mm, the ulnar nerve is located on the medial side with a mean distance of 5.46 ± 1.67 mm.

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  Fig. 5 Vein branch observed in the axillary region and basilic vein extracted from the insertion site. (A) Vein branches in the axillary region that are wide enough for a catheter to pass through, which are divided by travel direction, upward or downward. (B) The thinly sliced basilic vein from the insertion site was placed under the measurement device, then a photo was taken and the precise diameter was measured using digital calipers.

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