Is ultrasound (US) guidance recommended for peripheral intravenous (IV) placement in the basilic vein?

From the Guidelines

Yes, placing an ultrasound-guided peripheral IV in the basilic vein is generally appropriate and often recommended. The basilic vein is a good option for US-guided IV placement because:

• It's typically larger than other arm veins, making it easier to visualize and access 1.
• It's usually deeper, which reduces the risk of infiltration and increases longevity of the IV.
• It's less mobile than more superficial veins, improving stability. When placing the IV:

• Use sterile technique
• Position the patient's arm comfortably, usually abducted and externally rotated
• Apply a tourniquet
• Use a high-frequency linear transducer
• Visualize the vein in both short and long axis views
• Choose an appropriate catheter length (often 1.75-2.5 inches)
• Use a shallow angle of approach (15-30 degrees) Be aware that the basilic vein is close to the brachial artery and median nerve, so careful visualization and technique are crucial to avoid complications, as noted in the guidelines for ultrasound-guided vascular access 1. Also, due to its depth, securing the catheter properly is important to prevent dislodgement. The use of ultrasound guidance for vascular access has been shown to reduce complications and improve success rates, making it a recommended practice for peripheral IV placement, including in the basilic vein 1.

From the Research

Ultrasound Guidance for Peripheral Intravenous Placement

• The use of ultrasound guidance for peripheral intravenous (IV) placement in the basilic vein is supported by several studies 2, 3, 4.
• A study published in 1999 found that ultrasound-guided brachial and basilic vein cannulation had a high success rate of 91% in patients with difficult intravenous access 2.
• Another study published in 2008 compared one-operator versus two-operator techniques for ultrasound-guided basilic vein cannulation and found that both techniques had high success rates, with no significant difference between them 3.
• A retrospective study published in 2024 found that ultrasound-guided placement of deep veins, including the basilic vein, resulted in longer dwelling times and fewer complications compared to blind insertion of superficial veins in children 4.
• The use of ultrasound guidance for peripheral IV placement is also recommended by the Society of Hospital Medicine, which suggests that providers should use real-time ultrasound guidance for peripheral intravenous line placement in patients with difficult peripheral venous access 5.

Benefits of Ultrasound Guidance

• Ultrasound guidance can increase the success rate of peripheral IV placement, particularly in patients with difficult venous access 2, 4.
• It can also reduce the number of attempts and complications associated with peripheral IV placement 2, 3, 4.
• The use of ultrasound guidance can also improve the safety and effectiveness of peripheral IV placement, particularly in patients who require rapid infusion or have limited venous access options 6.

Techniques for Ultrasound-Guided Basilic Vein Cannulation

• The one-operator technique, where a single operator holds the transducer and attempts cannulation, is a common approach for ultrasound-guided basilic vein cannulation 3.
• The two-operator technique, where a second operator holds the transducer while the first operator attempts cannulation, is also effective and may be preferred in certain situations 3.
• The choice of technique may depend on the operator's experience and preference, as well as the patient's anatomy and venous access needs 3.