Brachial Vein Placement Research Paper

The Importance of PICC Tip Placement and Vein Selection
Jason Sylvia
Western Governors University
LUT1

I. Introduction:
a. Audience Hook: Catheter occlusion is a mechanical complication that occurs in 2% to 18% of PICC insertions. (Turcotte S, 2006) The incidence of thrombus varied by placement site 10% brachial vein, 14% basilic vein and 57% cephalic vein. (Allen AW, 2000) Proper tip placement in the SVC decreases complications of the vessel and heart. (Furie B, 2008)
b. Thesis Statement: Research suggests the importance of proper vein choice and PICC tip location markedly decreases catheter related complications in patients because correct vein placement have a decreased risk of thrombus, and correct tip placement
results in less risk of complications.
c. Preview of Main Points:
i. Correct vein placement have a decreased risk of thrombus. ii. Correct tip placement results in less risk of complications.
II.
Correct vein placements have a decreased risk of thrombus.
a. Choosing the best vein for access has a direct effect on possible future complications
i. The incidence of thrombus associated with cephalic vein placement is 57% (Allen AW, 2000) ii. The incidence of thrombus associated with basilic vein placement is 14% (Allen AW, 2000) iii. The incidence of thrombus associated with brachial vein placement is 10% (Allen AW, 2000)

III. Correct tip placement results in less risk of complications.
a. “PICC positioning within the lower SVC-CAJ region leads to fewer subsequent malpositions, decreased rates of catheter and venous thrombus and infection, and better overall catheter performance.” (TM, 2003)
b. In a left sided PICC placement if the catheter is too short the tip will poke into the right wall of the SVC, constant movement of the PICC from cardiac pulsation and patient movement may cause damage and increase risk of thrombosis. (Puel V, 1993)
IV. Conclusion
a. Restatement of thesis: The importance of proper vein choice and PICC tip location markedly decreases catheter related complications in patients.
b. Summary of main points:
i. Correct vein placements have a decreased risk of thrombus. ii. Correct tip placement results in less risk of
complications.
c. Closing comments:
i. We need to educate healthcare professionals about inherent risks associated with poor venous choice when placing PICCs to limit the risks to the patients. ii. Use of modern technologies can eliminate the guess work in PICC line tip placements ensuring proper tip placement and limiting complications associated with PICC malposition.

Scripted Audience Questions

Question: Who determines what is the correct placement of a PICC line.
Answer: There are several associations that have researched catheter complications including the INS (Infusion Nurses Society), AVA (Association for Vascular Access) and the FDA to name a few. Through their research have come up with the best placement of PICC lines that produce the least amount of complications.
Question: If PICC lines have so many possible complications why can’t regular peripheral IV’s be used instead?
Answer: PICC lines are necessary due to the length of therapies, type of therapies and patient access. Regular IV’s only last a few days and need to be replaced regularly. Some IV therapy can last weeks and even months, with a PICC line they only require the one line instead of several. Finally some patients have very poor peripheral vein access and peripheral IV’s aren’t an option.
Question: What happens if the PICC tip is in the heart instead of the SVC?
Answer: Some would argue that proper placement is in the right atrium, but studies have shown that catheter tip placement in the right atrium can cause cardiac arrhythmias including ventricular tachycardia, palpitations, and premature ventricular contractions. (TM,
2003)

Bibliography
Allen AW, M. J. (2000). Venous thrombosis associated with the placement of peripherally inserted central catheters. Journal of Vascular Interventional Radiology, 1309-1314.
Furie B, F. B. (2008). Mechanisms of thrombus formation. New England Journal of Medicine, 938-949.
Puel V, C. M. (1993). Superior vena cava thrombosis related to catheter malposition in cancer chemotherapy given through implanted ports. Cancer, 72:2248-2252.
TM, V. (2003). Central venous catheter tip position: a continuing controversy. Journal of Vascular Interventional Radiology, 527-534.
Turcotte S, D. S. (2006). Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg.