Ultrasound anatomy of peripheral veins and ultrasound-guided venipuncture

Abstract

As the specialty art and practice of placing intravenous devices continues to evolve, ultrasound provides a means to identify, assess, and insert catheters resulting in greater success and patient safety. The identification of peripheral veins can be challenging due to skin color, vein size, depth, and distribution. With ultrasound assessment, the identification of veins is enhanced, not only allowing determination of location but also leading the clinician, with knowledge of vessel size and vein health, to the selection of better insertion sites. The insertion of peripheral venous access devices into the small veins of the arm is a skill requiring fine motor movement. The insertion of these devices is primarily done in the upper extremities. Veins of the lower extremities may be used in pediatric patients or critically ill adults requiring femoral access. This chapter is focused on ultrasound-guided insertion in the arm and offers a brief overview of the identification of veins with venous anatomy specific to upper arm, assessment of the vasculature and a step-by-step process of insertion of peripherally inserted central catheters (PICCs).