What veins are commonly used for midline catheters, Peripherally Inserted Central Catheters (PICCs), and Central Venous Catheters (CVCs)?

Veins Used for Midline Catheters, PICCs, and CVCs

Midline Catheters

Midline catheters are inserted via the antecubital fossa into the basilic or cephalic veins, with the catheter tip terminating in the proximal upper arm below the axillary line. 1

• The basilic vein is preferred because it provides greater blood flow and lower risk of mechanical or chemical phlebitis 2
• The cephalic vein is an alternative access site, though it carries higher rates of thrombosis due to smaller size and susceptibility to kinking as it overlies the biceps muscle 1
• The brachial vein can be used but carries greater risk of injury to the brachial artery and median nerve 1
• The catheter tip remains in peripheral veins and does not extend beyond the axillary line, distinguishing midlines from central catheters 1, 2

Peripherally Inserted Central Catheters (PICCs)

PICCs are placed via peripheral veins of the upper arm—primarily the basilic, brachial, or less frequently cephalic veins—and advanced into the superior vena cava. 1

• The basilic vein is the access vein of choice because it is superficial and usually the largest vein in the arm 1
• The brachial vein is an alternative but carries higher risk of arterial and nerve injury 1
• The cephalic vein should be avoided when possible, as it has significantly higher failure rates (100% failure rate for left cephalic vein access in one study) and increased thrombosis risk 1, 3
• Right-arm access through the basilic or brachial vein is more appropriate for successful non-fluoroscopic PICC insertion compared to left-arm or cephalic vein access 3

Central Venous Catheters (CVCs)

CVCs are inserted into central veins, with the internal jugular, subclavian, and femoral veins serving as the main access sites. 1

Primary Access Sites:

• Internal jugular vein (especially right side) is preferred for most CVCs due to its direct trajectory to the cavo-atrial junction and lower complication risk 1, 4
• Subclavian vein is recommended for non-tunneled CVCs in adults due to lower colonization and thrombotic complication rates compared to femoral access 1
• The subclavian vein should be avoided for hemodialysis catheters to preserve the ipsilateral extremity for permanent dialysis access 1

Alternative Access Sites:

• Femoral vein should be avoided unless contraindications exist for other sites (e.g., SVC syndrome) due to higher infection and thrombosis rates 1
• The cephalic vein in the deltopectoral groove can be accessed via open cut-down technique, which is the best approach to avoid immediate complications 1
• Axillary vein and external jugular vein serve as additional potential access sites 1

Important Caveats:

• For tunneled catheters and ports, the catheter is threaded into the subclavian, jugular, or femoral vein after tunneling through subcutaneous tissue 1
• Ultrasound guidance significantly reduces mechanical complications and increases first-attempt success rates for internal jugular and femoral vein access 4, 5
• The catheter tip should be positioned at the junction between the right atrium and superior vena cava for optimal function 1