I did a picc with a pt sitting in a chair in an outpt oncology unit due to pt having a bad back and unable to lay in a bed. Everything went fine, but I wouldnt recommend it unless the chair elevates, my back was killing me from bending over. At the time and still currently we place piccs in the antecubital due to no ultrasound equipment. I dont think I would try a ultrasound picc with pt in a chair.
I have done it once for a peds patient in the OR, positioned for spinal surgery. Did not use ultrasound. It was a bit challenging, but the line went in and was nicely positioned in the cava.
This would have been a little trickier--300-lb patient with ARDS d/t bacterial pneumonia and blastomycosis,on a ton of IV meds. They were keeping him prone for 8-10 hours at a time---supine his sat's were in the low 80's even on 100% O2,prone he did ok with 60%. I had actually found a good site to go in but the staff turned him supine early for me. One thing I couldn't work out is how to accurately measure for trimming the line--short of just an educated guestimate--and what to do if I couldn't get the line out of an IJ. Here's a link,BTW.
This would have been a little trickier--300-lb patient with ARDS d/t bacterial pneumonia and blastomycosis,on a ton of IV meds. They were keeping him prone for 8-10 hours at a time---supine his sat's were in the low 80's even on 100% O2,prone he did ok with 60%. I had actually found a good site to go in but the staff turned him supine early for me. One thing I couldn't work out is how to accurately measure for trimming the line--short of just an educated guestimate--and what to do if I couldn't get the line out of an IJ. Here's a link,BTW.
http://www.ards.org/learnaboutards/whatisards/faq/faq15.html