neonates peri.iv insertion and documentation.

[johan john]

Can you get me tips for peripheral iv insertion in neonates?most of our babes are ex.preterms and our docs keep uvc's and vac's for max of 10 days but sometimes they need TPN's and multiple antibiotics for long duration ,even upto two months.most of our docs are against PICC's because they fear infections.They prefer peripheral better.there are no specially trained ones but we do on experience.some times it is terrible we give blind pricks..How do you document the site of insertion? we simply document it as on left hand or right hand but antomically how can I make clear documentation?

[iluvivt, BSN, RN]

I can understand the short term use of UACs &UVCs due to their high rate of colonization and catheter-associated blood stream infection. Neonates with shorter term therapy can get away with the use of peripheral sites. So if you use a UAC or UVC for ten days and then a peripheral for 4-7 days that is accepatable. Anything more long term or anything that must be given in a central vein (ie TPN) or anything that is optimal to give in a central line (for example in neonates K+ and Calcium preparations) should be. So...the MD should either place a central line or better yet have a PICC nurse trained in neonatal insertion insert the PICC. The MDs may be misinformed as PICC lines cared for properly have an extremely low infection rate in both the adult and pediatric populations. When inserting peripherals you should not attempt a vein (without ultasound) unless you can see it or feel it. This also includes using a vein light or vein finder. These little gadgets work really well in the neonates. If you do not have one contact the vendors for a demonstration..Now about charting... Chart the location of the site ..# of attempts..gauge and length of the catheter....flush used and ease of flush....any tubing added an in neonates I would also chart that after securement of the site the circualtion or capillary refill was good. Please remember that this population of patients is vey prone to infiltration and extravasation injuries and they can be very severe and cause permanent injury. I can not stress enough the importance of knowing what you are infusing (ph and osmolality) or in other words what is irritating and what causes necrosis should get into the tissue. There have been more lawsuits regarding these issues in peds then all other pt populations put together. In addition, in most states the statue of limitations is much much longer. So it is good you are asking these ?s Did I answer all your ?s