With the widespread adoption of ultrasound-guided (USG) techniques, the traditional landmark-guided infraclavicular approach for central venous cannulation has declined in use. The subclavian vein offers distinct advantages, and there are circumstances where central venous catheter insertion into the subclavian vein (SCV) is necessary, particularly when access to the internal jugular vein is difficult. When the conventional method is challenging, alternative strategies for SCV cannulation are required. This review examines current concepts and available evidence regarding USG supraclavicular brachiocephalic vein (SC-BCV) and infraclavicular axillary vein (IC-AXV) cannulation as practical alternatives for central venous access. USG SC-BCV cannulation has several advantages, including a shorter distance to the target vein, a more direct catheter trajectory to the superior vena cava, and reduced risks of pneumothorax and arterial puncture. Comparative studies and meta-analyses demonstrate higher first-attempt success rates and lower malposition rates compared with landmark-guided IC-SCV cannulation. USG IC-AXV cannulation is also increasingly recognized as a safe and effective option, particularly useful in patients with tracheostomy, chest wall injuries, or infection risks near conventional sites. Evidence suggests that success rates are comparable to those of internal jugular vein (IJV) cannulation, with fewer infectious complications in selected patients. Both SC-BCV and IC-AXV approaches require proficiency with long-axis imaging and precise needle tracking but can be mastered with training. Accumulating evidence supports USG SC-BCV and IC-AXV cannulation as reliable alternatives to both landmark-guided IC-SCV and USG IJV approaches.

Purpose
Patients with coronavirus disease 2019 (COVID-19) should be isolated from others to prevent widespread infection. The purpose of this study was to evaluate the feasibility of performing peripherally inserted central catheter (PICC) placement in patients with COVID-19 isolated in the intensive care unit (ICU) of a small volume center hospital.
Methods
This retrospective study included 79 patients who underwent PICC in 2 ICUs. There were 41 patients with COVID-19 who were isolated in an ICU (isolated ICU) and there were 38 patients who required ICU care who did not have COVID-19 (non-isolated ICU). Their medical records including PICC-related complications and clinical variables were compared.
Results
PICC placement was performed to maintain long-term intravenous access for 78% of the COVID-19 group and 52.6% of the non-COVID-19 group (p = 0.017). The mean procedure time (minutes) was 15.2 ± 7.58 in the COVID-19 group and 12.6 ± 6.65 in the non-COVID-19 group (p = 0.109). When PICC tip locations were divided into three groups (optimal, suboptimal, and malpositioned), there was no significant difference between the two groups of patients. PICC-related complications in COVID-19 and non-COVID-19 groups included non-functioning catheter (0% vs. 5.3%, p = 0.137), occurrence of swelling or hematoma around PICC inserted site (2.4% vs. 0%, p = 0.333), and PICC-related infection.
Conclusion
PICC placement for patients with COVID-19 isolated in the ICU of a small volume center hospital was feasible and safe.

Citations

• Analysis of Risk Factors for Peripherally Inserted Central Venous Catheter-Associated Bloodstream Infection
  Sungho Lee, Kwanhoon Park, Kang Yoon Lee, Dongbeen Choi, Ji Young Jang
  Journal of Acute Care Surgery.2024; 14(1): 9.     CrossRef

Purpose:

Ensuring the stability of central venous catheter placement for treating patients hospitalized in an intensive care unit is very important. Although PICC requires an ultrasound and fluoroscopy machine, it is difficult to use a fluoroscopy machine for PICC insertion in the intensive care unit. This study analyzed the cases of the insertion of a PICC under ultrasonic guidance at the bedsides in the intensive care unit to determine the usefulness of PICC in the intensive care unit.

Methods:

A retrospective study was conducted on patients hospitalized in the surgical intensive care unit and received PICC using ultrasonography at their bedsides from October 2015 to January 2018.

Results:

One hundred and twenty patients were collected. The number of successful PICCs stood at 105 patients, which was equal to 87.5%. Among them, 65 and 55 cases had left and right insertion, respectively; the corresponding success rate was 81.8%, and 92.3%. No statistically significant difference in success rates was observed between the left and right, as well as in the success rates depending on the presence of shock, sepsis, acute kidney injury, and mechanical ventilation. In the failed 15 cases, seven cases were due to the course of the procedure and eight cases were confirmed have been malpositioned after insertion.

Conclusion:

PICC at the bedside in an intensive care unit is a safe method for central venous catheterization without severe complications and death. The insertion sites, left or right, are equally acceptable. Further study of the cases of malposition will be necessary.

Citations

• Anatomical Structures to Be Concerned With During Peripherally Inserted Central Catheter Procedures
  Dasom Kim, Jin Woo Park, Sung Bum Cho, Im Joo Rhyu
  Journal of Korean Medical Science.2023;[Epub]     CrossRef
• Peripherally inserted central catheter procedure at the bedside by a nephrologist is safe and successful
  Seong Cho
  Kidney Research and Clinical Practice.2021; 40(1): 153.     CrossRef