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Tips for inserting PICC/MID to a patient with a contracted arm

Hello guys! Im back to ask another question. As the title stated. Please share you tips and tricks inserting a PICC/MID to a patient with contracted arms (very difficult to extend that arm without using force) and they are not cooperative. I tried cephalic approach however it is very rare for me to find a good cephalic vein for these type of patients. THANK YOU!

Ibraheem Y Aljediea
Ibraheem Y Aljediea's picture
Hello Jibles

Hello Jibles

In our hospital my team does a good deal of geriatric patient, contracted sometimes and here is what we do :

1-the puncture with ultrasound will be horizontal or upward if it is for the basilic vein “ need practice in using ultrasound in horizontal approach”.

2-we have no problem whatsoever with the brachial as option 2 in our practice if it is there

3- even we are avoiding the cephalic but we do as option 3 , usually no problem because its at the lateral side of the arm.

ibraheem aljediea

johns hopkins aramco healthcare

saudi arabia

Thank you so much for your

Thank you so much for your response! Can you please elaborate the horizontal approach and how is it applicable to patient with severely contracted arms. Thank you! 

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