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Emergency department confirmation of peripherally inserted central catheter placement by bedside ultrasound
© Springer-Verlag London Ltd 2009
Received: 29 July 2009
Accepted: 1 September 2009
Published: 26 September 2009
A 28-year-old woman presented to the emergency department (ED) for acute respiratory distress from an extended care facility, where she was rehabilitating from a traumatic brain injury (TBI) and remained comatose. On arrival, the patient was tachycardic, with a sinus rhythm on monitor at 140 bpm. She was placed on a ventilator with settings as previously recorded at the nursing home. Blood pressure was 84/56 and temperature 37.8°C. Physical exam revealed good breath sounds bilaterally, heart was tachycardic without murmur, abdomen was scaphoid without guarding, and skin was warm to touch. Her only venous access was a peripherally inserted central catheter (PICC) line in her right antecubital fossa.
A bedside ultrasound was performed by an emergency physician to confirm placement of the patient’s PICC line. Verification of placement can rapidly be determined with ultrasound by following the peripheral vein of insertion—commonly cephalic, basilic, or brachial—through to the subclavian vein. A quick look at the neck and heart will also ensure the catheter tip has not inadvertently migrated into the internal jugular (IJ) vein or right side of the heart.