Question 7

Describe the anatomy of the antecubital fossa and peripheral veins of the upper arm relevant to a peripherally inserted central venous catheter (PICC). 

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College Answer

Knowledge of anatomy of the areas of the body where common procedures are performed 
in the intensive care unit is essential. Defining the question by giving the boundaries and 
contents of the antecubital fossa along with a diagram illustrating the arrangement of the 
veins would have constituted a pass. The course of the basilic vein and an explanation of 
why it is favoured over the cephalic vein (presence of the clavipectoral fascia which provides 
an acute angle for the catheter to negotiate along with a valve frequently located at the 
junction) was important applied anatomy relevant to PICC line insertion. Transposition of 
medial and lateral structures was a common error in answers to this question.