Cannulation of the brachial and cephalic veins of the upper extremity

Peripheral venous cannulation can sometimes be unsuccessful after multiple attempts – even with attempts at the relatively larger antecubital veins. In this case, one might consider attempting cannulation of the brachial or cephalic veins. These veins lie deeper in the structures of the upper arm and are not readily palpable. Consequently, these veins are not generally used for intravenous catheter placement in the absence of ultrasound guidance. In most patients, the depth of these vessels requires that a longer intravenous catheter (1.75–2.0 in) be used. Caution should be exercised with the more proximal brachial vein because it lies immediately adjacent to the ulnar and median nerves.

Focused question

1. Where is the target vein?

Anatomy

The axillary vein divides into the cephalic vein, which runs superficially toward the lateral (dorsal) aspect of the upper arm; the basilic vein, which courses superficially along the inferior and medial (ventral) aspect of the arm; and the brachial vein, which runs deeply inferior to the biceps muscle (Figure 13.1). The basilic and cephalic veins rejoin in the antecubital fossa, and the brachial vein runs deep in this location. Frequently, the brachial vein will be found as paired superficial and deep brachial veins.

Technique

Probe selection

Generally, a high-frequency linear transducer is used.

Special equipment

For deep vein cannulation, a longer catheter is required (at least 2 in). Sterile probe covers (described in Chapter 12) can be used for sterile peripheral access.