Upper Limb
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
Superficial venous systemThe dorsum of the hand displays the dorsal venous network which drain into the cephalic and basilic veins on the lateral and medial side, respectively.The cephalic vein ascends on the lateral side of the forearm and arm and it passes through the deltopectoral groove in the shoulder before emptying into the axillary vein.The basilic vein runs posteromedially to pass anterior to the medial epicondyle of the humerus. In the arm, it pierces the brachial fascia and joins the paired deep brachial veins to form the axillary vein.The median cubital vein connects the cephalic and basilic veins anterior to the cubital fossa.
Persistent left superior vena cava
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček in Congenital Heart Disease in Adults, 2008
A persistent left superior vena cava can be demonstrated by echocardiography, preferably by transesophageal echocardiography, visualizing it laterally to the left atrium in the transverse projection (Figures 19.2–19.4). The course and entry of the persistent left-side superior vena cava is evident in the longitudinal projection (Figures 19.5 and 19.6). Suspicion of a persistent left superior vena cava is raised by the presence of an enlarged coronary sinus, dilated to >15mm in adults, which can also be well visualized by transthoracic echocardiography in the parasternal long-axis view (Figure 19.7). The diagnosis will be confirmed by contrast echocardiography with intravenous administration of agitated saline or an echo-contrast medium into the left brachial vein. The contrast medium will first appear in the left-side superior vena cava and in the dilated coronary sinus (Figures 19.5, 19.6, 19.8, and 19.9), and enters then the right atrium (Figure 19.10). The contrast medium applied to the left brachial vein does not appear in the right superior caval vein, unless there is a communicating vein between the right and left vena cava (Figure 19.11). In the presence of a coronary sinus defect, the contrast medium also appears in the left atrium (Figures 19.12 and 19.13).
Vascular access
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
For peripheral access, the arm is stabilized on a support board. Standard, sterile skin preparation is carried out and a local anesthetic injected after selection of an appropriate entry site to the basilic or cephalic vein, usually above the elbow (Figure 1.5a and b). The vein is punctured with a 21-gauge needle or 22-gauge cannula. Aspiration of blood confirms successful puncture. A 0.018-inch (0.5 mm) guidewire is then advanced into the vein. If resistance is felt at this point, the needle or cannula should be repositioned (it is usually too far in). An appropriately sized PICC is selected. The needle or cannula is removed and a peel-away sheath of diameter just sufficient to accept the PICC is advanced over the guidewire. The guidewire should be fixed relative to the patient, and pressure applied over the puncture site as this is done. The guidewire and the dilator of the peel-away sheath are then removed, and the PICC inserted into the sheath. It is usually easier to advance the PICC to a central position if its stiffening wire is left in. In certain places, especially near the termination of the cephalic vein in the deltopectoral groove, it may be easier to fix the stiffening wire and advance the PICC over it, unsupported. When the tip lies in the low SVC or upper right atrium, the peel-away sheath is split and removed, aspiration of blood is confirmed, and the catheter is flushed with normal saline. It is then sutured to the skin, and a transparent occlusive dressing applied. When no suitable superficial vein is available, ultrasound-guided puncture of a brachial vein (vena comitans of the brachial artery) is usually successful.
Superficial location of the brachial plexus and axillary artery in relation to pectoralis minor: a case report
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
K Keet, G Louw
The axillary artery is a continuation of the subclavian artery once it has passed over the first rib. The pectoralis minor muscle is located superficial to the axillary artery and it is this relationship that is used to divide the artery into three parts. The first part of the axillary artery is situated between the first rib and the superior border of pectoralis minor, the second part is deep to pectoralis minor, and the third part is located between the inferior borders of pectoralis minor and teres major muscles, after which it is known as the brachial artery.5 The axillary artery is accompanied by the axillary vein, a continuation of the brachial vein at the inferior border of teres major. The axillary vein is superficial to the axillary artery and becomes the subclavian vein as it crosses over the outer border of rib one.6
A narrative review of historic and current approaches for patients with difficult venous access: considerations for the emergency department
Published in Expert Review of Medical Devices, 2022
Andrew Little, Drew G. Jones, Kimberly Alsbrooks
Ultrasound-guided PIV catheter placements may be inserted in any vein of the upper extremities. While deep arm veins (e.g. cephalic, basilic, and brachial veins) are often attempted, these veins may be challenging to access [27,28]. Since standard-length PIV catheters often dislodge from deep arm veins, longer PIV catheters have been recommended [27]. One systematic review of 16 studies of long PIVs (6 cm to 15 cm, with 8 cm being most frequent size, was published by Qin et al., 2020 [29]. This review reported that long PIVs can be safe and reliable in children and adults and shows value in DVA; however, catheter failure rates were shown to vary widely, from 4.3% to 52.5% with leakage, infiltration, and dislodgement, being most frequent causes of failure reported. Furthermore, longer PIV catheters may often not be stocked within emergency departments, further restricting treatment options for DVA in certain situations.
Endovascular arteriovenous fistulas— are they the answer we haven’t been looking for?
Published in Expert Review of Medical Devices, 2021
Bynvant Sandhu, Charlie Hill, Mohammad Ayaz Hossain
Given the relatively new development of the technology, there are only a handful of notable clinical trials in Endovascular AVF creation (Table 1). Early, small studies of endovascular AVF demonstrated excellent short-term patency (96%–100% at 6 months) and acceptable mean maturation times of approximately 60 days [30,31]. One of the earliest clinical trials was a single arm, prospective six-week trial of the Ellipsys device. Twenty patients were recruited, examining two primary endpoints: creation of AVF with the device and fistula patency on Doppler examination. Inclusion criteria included 2 mm diameter of both radial artery and adjacent vein. This study reported an 87% patency rate at 6 weeks. No major complications were reported; however, 87% of AVFs required an additional procedure, including balloon dilatation and venous transposition. This study demonstrated the importance of brachial vein embolization (required in 26% of the patients) to reduce the flow in the deep venous system [32].
Related Knowledge Centers
- Arm
- Axillary Vein
- Basilic Vein
- Teres Major Muscle
- Brachial Artery
- Body
- Vena Comitans
- Deep Vein
- Radial Veins
- Ulnar Veins