PROCEDURE: Dual lumen PICC with ultrasound and fluoro
INDICATION:
DATE:
ACCESS SITE: vein with ultrasound
OPERATOR(S): , MD (Attending)/ , MD (Fellow)
MEDICATIONS: 2% Lidocaine without epinephrine for local
FLUOROSCOPY TIME: minutes
CATHETER: 5 French dual lumen power PICC
COMPLICATIONS: None immediate
TECHNIQUE:
The risks, benefits, and alternatives to the procedure were explained. Consent was obtained for PICC placement and contrast administration.
The upper extremity was ultrasonographically evaluated. An appropriate vein was identified, and the site was prepped and draped in sterile fashion. A timeout was performed. Using local anesthetic and under direct ultrasonographic visualization, the vein was punctured with a 21 gauge needle. An image was stored to PACS.
A 0.018″ wire was passed centrally and the needle exchanged for a dilator peel-away combination. The wire was used to determine catheter length, and a 5 French dual lumen PICC line cut to appropriate length. The tailored catheter was advanced through the peel-away and positioned centrally using fluoroscopy.
The peel-away was removed, and hemostasis achieved with manual compression. The catheter was aspirated, flushed, and heparinized per protocol. It was secured in place with 3-0 Ethilon. An antimicrobial disc and sterile dressing were applied.
The procedure was well tolerated, and the patient discharged from the angiography suite in good condition.
Findings:
- Vein patency and needle entry were documented by ultrasound and an image was stored to PACS.
- The catheter tip is near the cavoatrial junction.
Impression:
Uneventful image guided placement of 5 French dual lumen PICC in the upper extremity as described.
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