Has anyone run into placing a PICC line for a pediatric patient with osteogenesis imperfecta? Does anyone have a pre checklist or special way to try to ensure that all measures are taken to prevent bone breakage during the PICC insertion procedure? We recently had a patient that was 5 months old who had a PICC placed and the ulna was broken during the procedure. Any ideas on whether or not the PICC should be switched to the other arm now that is is splinted or are we just running another risk of breaking the other arm? Are PICC lines "contraindicated" in these patients? Thanks!
These patients can be extremely challenging in placing any type of vascular access. In infants I make every effort to use the scalp (after parental education) if veins are available, for both PIVs and PICCs to preserve extremity veins for use as child ages and because fracture risk is less. Sedation in somewhat older patients would also be helpful to reduce the need to secure extremity as firmly (read..tight grip). However, I have also referred these patients fo a surgically placed cvl if their needs are long term or if their access is too poor to provide good chances of PICC success.
While PICC may not be contraindicated, I would consider each patient carefully and involve the parents in discussion as well. No checklist but individual assessment.
In the case you are referring to, I would be more inclined to leave the current PICC rather than replace in the other arm. Frequent monitoring, of course.