We use oral sucrose for minor painful procedures, such as heelsticks and PIV insertions. Sometimes oral sucrose is enough to keep an infant comfortable during a PICC insertion, but with the bigger infants it just doesn't do it. Our doctors don't want to prescribe even a single low dose of morphine for those babies that are pulling away and crying. What do you use? Is there something between oral sucrose and morphine?

Our PICC orders are for Fentanyl or Morphine, but sometimes they don't need anything and sometimes the meds don't seem to help at all.

Lidocaine? Emla cm a topical numbing agent is all I've ever used

Fentanyl

Morphine sometimes

We give Versed and that seems to cover most babies. Some need a second dose.

stat dose of Fentanyl!

Fentanyl and Versed always unless they don't have any other access in which to give it. May possibly be redosed if no effect depending on the baby.

As a newer NNP, I came into a practice where the "more experienced" NNPs tended to restrain the infants hand and foot and give sucrose for PICC insertions. A few of the newer girls and I have adopted an approach that includes swaddling the infant with only the necessary extremity left out, as well as sucrose administration and Fentanyl if the infant requires it. If I can fairly confidently say that I will be able to insert the PICC with one stick, I may forgo the Fentanyl if the infant is otherwise calm and contained by the swaddling, however I tend to err on the side of giving the dose rather than witholding it. I have also occasionally given oral or intranasal Versed to an infant lacking other IV access. On a side note- some of the "more experienced" NNPs can't figure out why we have a higher percentage of successful insertions, and can perform them more quickly... Hmmm....

Fentanyl or nasal versed if no IV access.

Sucrose, swaddling, Fentanyl, Versed.

we ALWAYS use fentanyl...sometimes versed too...on the larger kids, sometimes sucrose too...