Peripherally catheter

  1. HI ! I would like to know about your experience in PICC. Sincerally
    •  
  2. 12 Comments

  3. by   NicuGal
    What do you need to know...we are backwards were I work and we have to BEG for them! Some places put them in quickly.

    We use them on poor IV access kids, long term antibiotics. We don't give blood thru them unless you can not get a new line in...the diameter is too small and can clot. We place them jugular, antecubital, saphenous or temporal. The nurses aren't allowed...it is usually a practitioner or fellow.

    We dress them with an occlusive dressing, which we don't change unless absolutely neccesary. Does anyone have a good anchoring style that will allow you to change the dressing?

    Anything else?
  4. by   dbscandy
    We use PICC's extensively now and have about 8 nurses certified to insert them. We place them early in vlbw babies and have had good success. We DO have a problem at times with infiltrates after they're in for a long period, but there has not been a baby with any lasting effect.

    They are placed on larger babies if there is a problem with access or if we know they will be placed on HAF/Lipids.

    We do not run blood through them.

    As for dressing changes, they are done once 24hrs after placed then once weekly unless drsg comes loose. The changes are only done by the nurses trained to place them. They are very good at this and most don't need assistance, but they use it as they are not egotistical in their talent. One good jerk of the kids extremity or head and it's over.

    The only thing that bugs me is having to remember to use ONLY a 10cc or larger syringe. We post signs at the bedside to prompt this, but that may be the problem with the infiltrates; some may forget and use a smaller syringe.
  5. by   dbscandy
    I forgot to mention the dressing. We use steri-strips on any line that may be out and on the proximal end, then tegaderm over all. Unless the PICC is occluded by bending the arm (antecubitals), we don't use any type of board.

    (And we will use just about any vein...there's a nice occipital one...out of the way of little hands; put on a knitted cap and pull the line through the little hole in the middle...voila! Neat and tidy)
  6. by   babynurselsa
    we use picc lines, though not nearly enough at our unit. I am one of several that have taken a class in placing them.
    We never give blood through them. One of the big pluses of picc lines is that usually they last intil IV access is no longer needed, though we do have the occasional infiltrate.
    I always secure the external remaining catheter with steri strips along with the wings. Then the entire area is covered with tegaderm.
  7. by   KathyPolewski
    I place the PICC's in our unit, as well as peds floors, and Peds ICU's. We Love them!! Don't you remember the days of sticking and sticking and sticking for IV's that only infiltrated hours after you finally found a vein? We usually start them within 12 hours of admission. Have had fantastic results. No infiltrates. We change the dressings every 7 days if the tip of the catheter if central, if it is an EDC (extended dwell cath), and the tip is not central, we don't change the dressing, unless it is loose.
    We post signs on the beds stating how many cm's is in, and exposed upon insertion, then you have something to go by. When we d/c them, we measure, to make sure that what went in, comes out.
    Good luck. If I can help you, let me know.
  8. by   robincourt
    How do you give small medication doses with a 10ml syringe? For example a med that is .3ml in volume and the baby is volume restricted? Do you have a policy/procedure on the maintenance and use of a PICC? Thanks for any help you can give.
  9. by   Gompers
    Quote from robincourt
    How do you give small medication doses with a 10ml syringe? For example a med that is .3ml in volume and the baby is volume restricted? Do you have a policy/procedure on the maintenance and use of a PICC? Thanks for any help you can give.
    That's exactly what I want to know.
  10. by   BamaGirlRN
    Picc's always have some sortof fluids running at my facility, TPN/IL, D10, etc. So with meds you can just put it on a pump and connect it to the port on the tubing. Picc's can clot very easily if nothing goes through them.
  11. by   fergus51
    Quote from robincourt
    How do you give small medication doses with a 10ml syringe? For example a med that is .3ml in volume and the baby is volume restricted? Do you have a policy/procedure on the maintenance and use of a PICC? Thanks for any help you can give.
    We give the .3 with a 1 ml syringe then flush with the 10ml syringe. I love piccs. We only change the dressings when needed (no scheduled changes), but do everything else the same as Kathy said.
  12. by   suzanne4
    Look at the original post, it was written over 4 years ago. Things have definitely changed since then.:wink2:
  13. by   Gompers
    Quote from suzanne4
    Look at the original post, it was written over 4 years ago. Things have definitely changed since then.:wink2:
    Yeah, but from what I understand they still recommend not using anything smaller than a 10cc syringe. We question it, too, because on a daily basis we're giving stuff like 0.1cc SIVP meds through our lines. They gave us new flushes - they're filled to 3cc but the barrel of the syringe is as big as a 10cc syringe, to give the same amount of pressure. We still give lots with a 1cc syringe though even though they keep telling us we're not supposed to. How else can you accurately give such small amounts?
  14. by   rainbows4me
    Quote from Gompers
    Yeah, but from what I understand they still recommend not using anything smaller than a 10cc syringe. We question it, too, because on a daily basis we're giving stuff like 0.1cc SIVP meds through our lines. They gave us new flushes - they're filled to 3cc but the barrel of the syringe is as big as a 10cc syringe, to give the same amount of pressure. We still give lots with a 1cc syringe though even though they keep telling us we're not supposed to. How else can you accurately give such small amounts?
    EXACTLY! Sure, you can say dilute it, but when you're dealing with a micropremie - doesn't take much for the c/k/d to through the roof! I find it happening all of the time with Fentanyl - I'm giving 0.13cc - you want me to put that in a 5cc syringe?? The dead space in that syringe is probably about that much! When it's not an issue of immediate timing, sometimes I'll give small amounts like that using the 1cc syringe but give it through an in-line port close to the baby. I don't clamp the line, so the pressure I'm using (in theory although I still question how much pressure can be created pushing .13cc) is absorbed by the tubing which is a large diameter - not the picc line. Our protocol is certainly different from our practice in this area. I wish there was a better way...

close
Peripherally catheter