The cephalic and basilic veins are both superficial upper limb veins used for peripherally inserted central catheter (PICC) placement, but their anatomical differences significantly impact clinical outcomes.
Anatomical Comparison
Cephalic Vein
- Course: Originates at the radial side of the dorsal hand, ascends the lateral forearm/arm, and terminates in the axillary vein via the deltopectoral groove.
- Depth Transition: Becomes deep in the upper forearm near the deltopectoral groove.
- Clinical Considerations: Proximity to the radial nerve increases risk of nerve damage during cannulation. Its tortuous path through the deltopectoral groove contributes to higher malposition rates (e.g., axillary/subclavian vein misplacement).
Basilic Vein
- Course: Originates at the ulnar side of the dorsal hand, ascends the medial forearm/arm, and merges with brachial veins to form the axillary vein.
- Depth Transition: Becomes deep around the mid-arm.
- Clinical Considerations: Straighter course reduces tortuosity-related complications. The right basilic vein is preferred for PICC placement due to a more direct route to the superior vena cava.
Implications for PICC Placement
| Factor | Cephalic Vein | Basilic Vein |
|---|---|---|
| Success Rate | Lower primary success (46.3% overall) | Higher success, especially right-arm (49.7%) |
| Malposition Risk | High (common in axillary/jugular veins) | Lower, but still occurs in subclavian/brachiocephalic veins |
| Vein Accessibility | Superficial in forearm, easy to locate | Deeper in mid-arm, but larger diameter |
Key Recommendations
- Right basilic vein is optimal for PICC placement due to anatomical straightness and lower malposition rates.
- Avoid cephalic vein for left-arm insertions, which have a 100% failure rate in some studies.
- Use ultrasound guidance to navigate anatomical variations (e.g., vein mergers or abnormal brachial vein patterns).
Malpositions often occur due to abrupt angles in the cephalic vein’s deltopectoral groove or operator inexperience. Slow catheter advancement and proper patient p ositioning (e.g., head tilt toward the shoulder) can mitigate risks.
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References
Nickel, B. et al., (2024, January/ February) Infusion Therapy Standards of Practice 9th edition. Journal of Infusion Nursing. https://www.ins1.org/publications/infusion-therapy-standards-of-practice/
Sadeghi, A. et al., (2017, October 15) Variation of the cephalic and basilic veins: A case report. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC5787337/
Jeon, E. et al., (2016, May 7) Which arm and vein are more appropriate for single-step, non-fluoroscopic, peripherally inserted central catheter insertion?National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/26847734/
Lacoul, A. et al., Peripherally inserted central venous catheter (PICC) insertion. AB Sono. https://www.albertasono.ca/picc-vascular-catheter/