PICC vs Periheral

[babynurselsa]

I need some help. I originally post this to the Neonatal discussion but need more feedback.

I work in a small Level 3 NICU. Our Neo is an Ols School sort of guy. He is very hesitant to allow us to place picc lines on kids that need longer term IV therapy. His rationale is that he does not want to put an invasive line in a kid if he can avoid it. Our Primary TPN solution is D12.5 HA. We also give lots of gentamicin, vancomysin, amikacin, acyclovir, etc. Now we all know that these solutions are vesicants etc. Plus our HA comes up with the label that clearly says in bold type "GIVE THROUGH CENTRAL LINE ONLY."

If we try and petition early on for a picc he will often say that he wants to get the kiddo of IV's in a few days etc. Then when everyting has been blown he will allow us to attempt a picc. Unfortunately this is when there is no acces left.

What I am needing is some journal articles, stats or other info regarding infection rates of piccs vs peripheral. Cost efficacy of the same.

He will sometimes alter his position if the proper information is presented.

Can anyone please help???

Needless to say this is a very difficult situation for us nurses. We are having babies stuck in excess of 20++ times in a single day. He thinks it is a skill issue, I assure you that it is not. Most of us are experienced nurses in our area.

I know all of the arguments, but I must have soem reputable documentation to present. I am working towards us developing a unit guideline so that this issue can possibly be put to rest. The Haldol in the coffe pot didn't do the trick so now I must do my homework.....

[KRVRN, BSN, RN]

My understanding is that the lumen of a PICC is too small to run PRBC's through.

As for q2hr art sticks for gases... I'm absolutely horrified! How sad! Not only is it painful, but the simple fact that you have to monitor gases that often tells me that the baby is very unstable and definitely can't handle frequent art sticks.

[NicuGal, MSN, RN]

My other question is this....do you document all these IV things with incident reports...your risk management should be picking up on this. If they are truly getting over 300 cc a day, I would have to refuse to do it. You must be having some major problems with electolytes and such with that heavy of a load. For a premature infant they should be 60-200cc/kg or higher with certain defects such as gastrocisis or icthyososis or such, then they can go to 350/day.

Unfortunately, you are stuck with this guy unless you can go to the director of the unit with it. And if he is it, then go higher. There are standards of care, but they vary widely. I don't think that all articles in the world are going to change this guy. Actually it sounds like you have more problems than PICC placement.

And the shortage for Wydase is because they don't make it anymore...wasn't making enough money for the company.

[Jolie, BSN]

I'm sorry it's taken me so long to find these articles for you, but here goes:

"Percutaneously Inserted Polyurethane Central Catheters in the NICU", Neonatal Network, vol.18, #6, September 1999, pp.37-45.

"Use of Percutaneous Silastic Intravascular Catheters in High-Risk Neonates", Neonatal Network, vol.9, #11, 1990.

The second article was written by Mary Kay Leick-Rude, who was the resource person for PICC lines in the NICU of Children's Mercy Hospital in Kansas City. I worked with her back in the late 1980's and had the utmost respect for her. She was extremely knowledgable about PICC lines, was instrumental in introducing them to the unit, and was responsible for inservicing every single staff RN, NNP, and resident on their use. I don't know if she still works there, but if she does, I would bet that she'd be willing to help you out by providing information, policies and procedures, or whatever you need to get a program started.

Are you in a teaching hospital or community hospital? If you are in a community hospital, chances are that there would be a teaching hospital nearby that you could contact for information and education on this subject.

Good luck to you, and thanks for caring so much about your babies!