What do you use for pain control for PICC insertions?

[ICN_RN]

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?

[Mimi2RN, ASN, RN]

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.

[tunafish1800]

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

[dawngloves, BSN, RN]

Fentanyl

[NeoNurseTX, RN]

Morphine sometimes

[jwendt]

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

[Julie Basilio]

stat dose of Fentanyl!

[littleneoRN]

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.

[LoveTheNICU]

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....

[BittyBabyGrower, MSN, RN]

Fentanyl or nasal versed if no IV access.

[karnicurnc, MSN, APRN, CNS]

Sucrose, swaddling, Fentanyl, Versed.

[EmilyPeruana]

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