Basilic vein

PN can be administered via a smaller peripheral vein (e.g., cephalic or basilic vein) or via a larger central vein (e.g., superior vena cava). Peripheral PN (PPN) is infused via a peripheral vein and generally is reserved for short-term administration (up to 7 days) when central venous access is not available. PN formulations are hypertonic, and infusion via a peripheral vein can cause thrombophlebitis. Factors that increase the risk of phlebitis include high solution osmolarity, extreme pH, rapid infusion rate, vein properties, catheter material, and infusion time via the same vein.20 The osmolarity of PPN admixtures should be limited to 900 mOsm/L or less to minimize the risk of phlebitis. The approximate osmolarity of a PN admixture can be calculated from the osmolarities of individual components ... 

The axillary vein is a large venous structure that represents the continuation of the basilic vein. It starts at the lower border of the teres major tendon and... 

Venous access can be obtained by several approaches. The internal jugular veins, subclavian veins, and femoral veins are aU potential sites for introduction of the pacing catheter into the right heart (Table 7.2). The median basilic veins and basilic veins can also be used, but these sites are associated with a very high incidence of catheter dislodgment (because of arm motion) and are rarely, if ever, used today. 

When ultrasound guidance is used, a preliminary examination of the upper arm is performed to identify a suitable access vein. The basilic vein is the preferred site. The cephalic vein can be used,but is prone to spasm and has an acute angle as it joins the axillary vein. The veins are typically imaged in the transverse plane while the (echo-enhanced) needle is advanced (Fig. 6.4). The transducer is rocked cephalad and caudad keeping track of the needle tip. When this... 

Fig. 6.4. Transverse ultrasound image of a needle tip within a basilic vein during a peripherally inserted central catheter insertion under ultrasound guidance...

On the basis of postmortum examinations the catheter was not thought to have contributed to death in three of 373 cases autop-sied. These three patients had basilic vein catheters, two of which were introduced by cutdown. One of these patients had extensive thrombosis of the vena cava and multiple pulmonary emboli, another septic thrombosis and the third had endocarditis involving the tricuspid valve. 

Sites external jugular, subclavian or basilic vein... 

Local anesthesia and regional blocks, commonly used in vascular access surgery, may affect vein diameter and fistula blood flow rates, which are important predictors of fistula failure. Regional block anesthesia (brachial plexus block) is associated with vasodilation in both the cephalic and basilic veins and with increased fistula blood flow. 

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