Safe and Efficient: PICC Catheterization Under Handheld Ultrasound Guidance
The technology of peripherally inserted central catheter (PICC) has a history of several decades. Ultrasound-guided PICC can intuitively display the anatomical structure of blood vessels, with advantages such as real-time guidance, full visibility throughout the procedure, shortened puncture time, and reduced complications. It not only alleviates the pain of punctured patients, but also provides nurses with a safe and effective infusion route. Ultrasound-guided PICC insertion technology largely avoids the shortcomings of traditional catheterization methods and greatly improves the success rate of catheterization.
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Selection of Veins for Ultrasound-Guided PICC
Veins can be classified into two categories: deep and superficial. Deep veins mostly run deep to the deep fascia and accompany arteries of the same name, also known as accompanying veins; superficial veins run in the subcutaneous tissue and are generally referred to as subcutaneous veins. Due to the fact that the course of upper extremity veins is shorter than that of lower extremity veins, and the right side is shorter than the left side, and superficial veins are superficial and easy to locate, the superficial vein of the right upper extremity is often selected for puncture and catheterization, which reaches the superior vena cava via the axillary vein.
For ultrasound-guided PICC, the basilic vein should be the first choice. Because the basilic vein is located in front of the elbow, it has a relatively large operation range, which is suitable for real-time monitoring by ultrasound personnel. Meanwhile, the basilic vein approach is the method with the least trauma and fewest complications for peripheral venous catheterization, which can significantly reduce the incidence of pneumothorax, hemothorax, air embolism, and nerve injury.
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Patient Positioning for Venous Ultrasound Examination
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Ultrasonic Manifestations of Normal Veins
1) Grayscale ultrasound: Normal extremities veins have the following four ultrasonic characteristics. ① The venous wall is thin; ② The intima is flat and smooth; ③ The blood flow in the lumen is echo-free, and high-resolution ultrasound equipment can display flowing red blood cells as weak echoes; ④ Compressibility, the lumen can disappear when pressure is applied with the probe.
2) Color Doppler: Normal extremities veins show unidirectional centripetal blood flow signals that fill the entire lumen. Superficial veins or small veins may have no spontaneous blood flow, but blood flow signals can appear in the lumen when the distal limbs are squeezed. When a certain external pressure is applied, the venous lumen disappears, and the blood flow signal also disappears accordingly.
3) Pulsed Doppler: Normal extremities veins have five Doppler characteristics, namely spontaneity, phasicity, Valsalva maneuver, enhanced blood flow signals during distal limb compression test, and unidirectional centripetal blood flow.
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Evaluation of Veins for Ultrasound-Guided PICC Catheterization and Determination of Puncture Sites
1) Vascular Assessment
The scope of vascular assessment during puncture should not be too small. Scan the blood vessels 2 finger breadths above the cubital fossa, and examine the depth, course direction, and bifurcation position of the vessels along their course; Measure the vessel diameter to check if it can accommodate the selected catheter; Observe the structures around the vessel, especially the condition of the accompanying artery, and check for any vascular variations—if there is an accompanying artery or vascular malformation, the vessel should be avoided; Examine the vessel for thrombus to determine if it is patent.
2) Determination of Puncture Site
The puncture site should be selected to avoid venous valves and branch veins. Puncture should be performed at a converged, relatively thick vein, avoiding adverse factors within the vessel. Most ultrasound-guided PICC catheterizations are performed at the basilic vein of the upper arm above the cubital fossa. The basilic vein in the upper arm is easier to locate, has a favorable course, and a larger diameter, requiring a shorter catheter length for insertion. In addition, this location has a higher blood flow rate, which is less likely to cause vascular wall injury. Meanwhile, limb movement at this location causes less friction and traction on the catheter, thereby reducing the stimulation of vascular walls caused by catheter movement within the vessel and lowering the incidence of complications such as vascular-related infections. It is also very beneficial for long-term catheter fixation.
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Advantages of PICC Under the Guidance of SonoMaxx Handheld Ultrasound
1) In terms of image quality, the SonoMaxx handheld ultrasound has reached the diagnostic level. Whether it is two-dimensional imaging or color blood flow imaging, it is comparable to large-scale ultrasound equipment and can meet the needs of bedside examinations.
2) After the device is connected, select the preset value to enter. It can start scanning with one key. The fan-shaped interface is simple to operate, and the compact and portable device is suitable for bedside operations.
3) The handheld ultrasound is equipped with professional needle guidance software. Puncture enhancement and central line guidance make puncture more accurate, which can further ensure the success rate of puncture.
SonoMaxx Handheld Ultrasound-Guided Puncture
Clinical Application Cases of SonoMaxx Handheld Ultrasound