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Adrian J. Esterman, PhD, FACE

Foundation Chair of Biostatistics, University of South Australia, Adelaide, Australia

presenter photoProfessor Adrian Esterman holds the Chair of Biostatistics at the University of South Australia. He is a highly experienced epidemiologist and biostatistician with a career including 7 years as a staff member of the World Health Organization based in Geneva and Copenhagen. In the last five years, he has been a chief investigator on over $3 million of competitive grants. He is the author of over 300 publications and has a current h-index of 39. His interest in vascular access was sparked by one of his students, Rebecca Sharp, who is also presenting at the Conference.

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Risk Reduction Track

F101 – Oral Abstract Presentations (F101)

Choosing the Largest Vein for PICC Insertion


clock3:00 PM - 3:15 PM

clockRoom: Potomac 1-2

CE Hours: 1.2 per four (4) 15-minute sessions

Adrian J. Esterman, PhD, FACE

Foundation Chair of Biostatistics, University of South Australia, Adelaide, Australia

Purpose/Design: Current guidelines for Peripheral Central Intravenous Catheter (PICC) insertion recommend that the smallest diameter catheter that meets the treatment needs be inserted into the largest diameter vein. However, there is little published literature to inform which vein might be the most suitable to use. The aim of this cross-sectional study was to determine the association between arm dominance, arm side (right vs left) and vein type with average vein diameter. Methods: Adult patients referred for PICC or midline insertion at a large metropolitan teaching hospital were recruited for this study. The PICC nurse measured the diameters of the basilic, brachial and cephalic veins in both arms of participants 10cm above the antecubital fossa, using an ultrasound with in-built calipers. Linear mixed effects models were used for the comparisons of vein diameters. Results: Arm veins of 176 patients were measured. Mean vein diameter was statistically significantly greater in male, taller, heavier and older patients. There were no statistically significant differences in mean vein diameter between the dominant and non-dominant, or right and left arms. Basilic veins had significantly greater mean diameters than brachial veins (mean difference = 0.46mm, p < 0.001) and cephalic veins (mean difference = 0.89mm, p < 0.001). Notably, where all 6 veins could be measured, the basilic vein was the largest in only 55% of patients; the brachial largest in 28%; and, the cephalic largest in 17%. Limitations: Patients from only one center were used, but do reflect a broad range of indications for PICC and midline insertion. Conclusion: With respect to vein size, arm choice is largely arbitrary. Although on average, the basilic vein was larger than the other two veins; we recommend that ultrasound be performed on both arms and all three veins to ensure that the most appropriate vein is identified.

Learning Objectives:

  • Express the most apprpriate vein for PICC insertion.
  • Reflect on differences in vein size by arm dominance.
  • Reflect on differences in vein size by type of vein.


MP3 Audio Slides