A palpable vein in the antecubital fossa provides a safe route for central venous access. A long, 60 cm, catheter is required.
There are two intercommunicating main veins, the Basilic and the Cephalic. (See image)
Ascends along the medial surface of the forearm; near the elbow, the vein changes to a position in front of the medial epicondyle where it is joined by the median cubital vein. It then runs along the medial margin of the biceps muscle to the middle of the upper arm, where it pierces the deep fascia to run alongside the brachial artery, becoming the axillary vein.
Ascends on the front of the lateral side of the forearm to the front of the elbow, where it communicates with the basilic vein through the median cubital vein. Then ascends along the lateral surface of the biceps muscle to the lower border of pectoralis major muscle, where it turns to pierce the clavipectoral fascia and pass beneath the clavicle. It then terminates in the axillary vein. There are valves at the termination of the cephalic vein. The sharp angles and valves may hinder the passage of a catheter along the cephalic system.
Median cubital vein
The median cubital vein arises from the cephalic vein just below the bend in the elbow and runs obliquely upwards to join the basilic vein just above the elbow. It is separated from the brachial artery by the bicipital aponeurosis, which is a thickened portion of deep fascia.
Apply a tourniquet to the upper arm to distend the veins. Select a suitable antecubital vein. Lie the patient supine with the arm supported at 45° to the body and the head turned towards you. Estimate the length of catheter needed to reach the superior vena cava. Puncture the chosen vein with the needle and cannula and remove the needle. Insert the catheter through the cannula and advance it a short distance (2-4 cm in adults, 1-2 cm in children) then release the tourniquet. Steadily advance the catheter along the vein until it is estimated to be in the correct position. Confirm position by aspiration of venous blood and chest X-ray.