Pediatric vs Adult PICC insertions

[BethGCRNI]

I have several years of adult PICC experience. I recently (August 2010) went to work in a pediatric setting. Everything has been going well. I am evolving and growing in experience every day. I have a great mentor with 30+ years experience in the pediatric IV therapy field. I had no idea the challenges and differences that I would encounter changing from the adult population to the child/neonate. In the past years I have only had 2 occurrences when I cannulated an artery accidently. I have been placing PICC's in children and neonates for 4 1/2 months now and in the past 2 weeks I have inserted 3 arterial PICC's. I have been quite upset about this.

My question is....any of you in the field that started with adults and are now working with children. Can you give me any advice, pointers? I insert both with superficial veins and with the ultrasound for other veins. I preferably use the basilic or cephalic vein but have used brachial as a last resort.

I really like working with the kids and want to do the best job possible. I want to learn and only do what is best for the kiddos. Looking for information from others that have moved from adults to children. Any advice is appreciated

Beth

Vascular Access RN:nurse:

[iluvivt, BSN, RN]

Are you scanning the entire arm..temporal areas or groin b/f each and every insertion? If not you need to do that and identify the veins and arteries and nerves...compress the veins...do their locations make sense to you based on an anatomy chart. You need to locate a good anatomy chart of infants and child's vascular system. Yes it can be difficult to identify on a child b/c of the obvious size differences between peds and adults....take the extra time before the insertion attempt and scan scan scan. Also as long as you have the advantage of the US why are you not using it for every insertion?

[BethGCRNI]

Thanks for your comment iluvivt. If a child has visible or palpable superficial veins then I don't necessarily see the need for US guidance. I use the US when I have a child with more adipose or deeper veins. Do you use the US even on superficial visible veins?

Thanks,

BEth

[iluvivt, BSN, RN]

I do on adults...but on infants and children it is wise to still look at that vessel with US so you can determine how large it is...look first without the tourniquet..then look at the deeper veins and compare the size to the more superficial ones. There are a few guidelines out there about the relationship between catheter size and vein size. The one I like to use is that the catheter should not take up more than 33 percent of the vein. So as you can see you need to really examine the available veins ans see which one will meet the criteria.

[BethGCRNI]

Thanks for your reply. I agree that it is a very good idea to look with the US. I placed a 3 FR single lumen PICC in an 8 month old with a really large basilic vein and then a while back had to place a 1.9 FR in a child almost 2 years old. The US is the sure way to make sure that the vein will indeed accomodate the catheter and not take up 50% of the vein. I appreciate your reply. I am new to pediatrics but not to IV Therapy/Vascular access. I still have much to learn with the kids.

Beth:nurse:

[iluvivt, BSN, RN]

No problem...I learn too by sharing