Ultrasound-Guided, Guidewire-Assisted Long Peripheral Catheter in the Great Saphenous Vein for Bilateral Upper Limb Fracture Surgery: A Case Report.

BACKGROUND: Establishing reliable venous access can be particularly challenging in trauma patients with bilateral upper limb fractures, where peripheral cannulation is unfeasible and central venous catheterization may be unnecessary or refused. CASE PRESENTATION: A 51-year-old woman (BMI 38 kg/m2) sustained bilateral elbow fractures requiring staged fixation. Because the patient expressed strong concern and reluctance toward central venous catheterization, and there was no clear indication for it, alternative options were explored. Ultrasound assessment revealed a suitable right great saphenous vein (GSV) with ≈ 3.6 mm of diameter. Under sterile and ultrasound-guided conditions, a 10-cm 18-G PowerGlide long peripheral catheter (LPC) was successfully inserted, providing stable access for perioperative management over 10 days, with no complications or malfunction. DISCUSSION: Midline and LPC are designed for intermediate-term therapy and are typically placed in upper-extremity veins. Their use in the saphenous vein for perioperative care has not been previously described. In this case, ultrasound-guided saphenous LPC placement provided an alternative route for vascular access in a patient with extremely difficult venous access, without catheter-related complications. CONCLUSION: Ultrasound-guided placement of a 10-cm LPC in the GSV provided perioperative venous access for 10 days without complications in this case. Further case series or prospective registries are needed to define patient selection, dwell time, and complication rates for lower-extremity peripheral vascular access.