We are looking into placing Peds PICCs and would appreciate any words of wisdom as far as navigation systems, catheter brands and sizes, sedation criteria, and any other advise. Thanks so much! Aileen Rogers RN VA-BC
We are looking into placing Peds PICCs and would appreciate any words of wisdom as far as navigation systems, catheter brands and sizes, sedation criteria, and any other advise. Thanks so much! Aileen Rogers RN VA-BC
Our PICC/Central Line Team will do pediatric PICCs but it is pretty rare since we don't keep severely ill kids here. If we get a consult, we talk with the nurses and parents and determine how the child reacts to blood draws, IV starts. I am not concerned about crying - I AM concerned with movement! So if the child is cooperative and will hold still, we always try to have the optimal setting possible: 2 PICC nurses, and Child Life specialist for distraction, buffered Lidocaine, and day shift. Ideally, once we know the child is cooperative, we enter the room, introduce ourselves, explain what we are going to do (based on the age and understanding of the child), and then do it right then. We use the buffered Lidocaine instead of EMLA or similar products that take time to numb - in that time, the child has the chance to get really scared and there go the veins!
We use ultrasound but not a tip locating system or ECG since the kids are not big enough for the TLS device, and the ECG is not approved in kids yet. You will find that you are very nervous for the first kid you do, but once you do one, you realize how good their veins are and that they are really easy sticks in most cases. Remember, I am talking about a relatively healthy pediatric population we see. I'm not talking about severely ill or compromised chronically ill kids. Most common would be for Lyme Disease.
If a child does need sedation, our Interventional Radiology dept will place the line (reluctantly) and arranges anesthesia to handle the sedation. You will find 4 yr olds that hold still and do just fine having it placed at the bedside and 13 yr olds that have to be sedated! We usually ask the parents to step out since it is a sterile procedure, and you will find that the child may do better without Mom there. If they insist on staying, we gown, glove, and mask them up if they are going to be up close - then watch them for fainting!
Hope this is helpful. We no longer stock PICCs smaller that a 4 french so the child also needs to have an upper arm vessel large enough to handle that size.
Wendy Erickson RN
Eau Claire WI