Ultrasound-Guided PICC Placement [CASE 01]

This Critical Care Cardiology educational case presents a step-by-step overview of PICC placement in the right upper limb, focusing on access through the basilic vein under ultrasound guidance. The case highlights procedural preparation in an intensive care environment, including antisepsis with chlorhexidine, sterile field organization, ultrasound probe protection, local anesthesia, and identification of vascular anatomy. Learners follow the reasoning used to differentiate vein from artery, perform venous puncture, introduce the guidewire, use the introducer kit, advance and test the catheter, and assess whether the catheter may have migrated toward the internal jugular vein. The case also reinforces the importance of catheter fixation, dressing, and radiographic confirmation of catheter position after placement. This content is intended for procedural education and should be reviewed within local protocols, supervision requirements, and institutional safety standards.

INCLUDED CONTENT

• Ultrasound-guided right basilic vein access demonstration
• Sterile preparation and antisepsis sequence
• Ultrasound probe cover setup
• Local anesthetic infiltration technique discussion
• PICC kit components overview, including guidewire, introducer, catheter, and scalpel
• Catheter measurement and trimming explanation
• Guidewire and introducer technique walkthrough
• Catheter advancement and introducer removal
• Flush and reflux assessment of both lumens
• Ultrasound-based reasoning to evaluate possible jugular migration
• Catheter fixation and dressing overview
• Reminder for post-procedure imaging confirmation

TARGET AUDIENCE

• Physicians in intensive care, cardiology, emergency medicine, anesthesiology, and vascular access training
• Residents and fellows learning ultrasound-guided vascular access
• Nurses and advanced practice clinicians involved in ICU vascular access workflows
• Medical educators teaching procedural anatomy and sterile technique
• Healthcare professionals reviewing PICC insertion principles under supervision

EDUCATIONAL NOTICE

This content is for medical and procedural education only. It does not replace hands-on training, institutional protocols, clinical supervision, or professional judgment. PICC insertion and catheter position confirmation must be performed by qualified personnel according to local standards, with mandatory human review and appropriate imaging or approved confirmation methods.