Hello everyone, Newbie here. New to PICCs, but not new to taking care of kids. I just completed a 2 hr marathon where 3 of us got the stuffing kicked out of us by a 2 year old. (BTW, I'm 6'4" 230#) Our PICC service assists the pediatric STAT RN staff when they are requested to place PICC lines. It usually takes 3 of us to hold, administer subtheraputic doses of benzos and analgesics, and stick. I suggest subtheraputic, because time after time we end up using BRUTAINE to just hold these wigglers down and hope for the best. The Peds attending staff are of the opinion that we need to "attempt first, then if necessary, we'll do moderate sedation" to really get them down. In my humble opinion (formulated over the past 25 years of ED, EMS and cath lab experience), this mindset is antiquated and just wrong. What are the rest of you guys doing ? I need ammunition because I'm gearing up for a fight...Thanks.
DB RN
Upstate NYÂ
And good luck to you big guy! I will say that I have minimal experience with pediatric picc insertion, but I was a peds nurse for 5 years in the ER, and I can tell you one thing for certian, if that was MY child you were sticking like that, I would have to hurt someone. There are other ways to do this. Try to appeal to your docs with their own kids. They will be more apt to listen to you. Any dad or mom would. Contact Darcy Doleman at Cinn. Ohio Childrens hospital. She could probably give you a lot of info. on how to help, and what to do.
Heather
I think an extra part of the pediatric PICC nurses role is assessing the child for their sedation needs or child life needs.
I may not have those skills but I rely on the skills of those PICC RNs, when I am working with them. They do the largest percentage awake with child life, with LMX4 topically and they do great. They probably do less than 5 a month with general anesthesia or sedation.
If it is their assessment that the child needs sedation or general anesthesia, they don't stick. I support them in following their judgment/assessment. Like you wouldn't give 80 mg IV Lasix to a 2 year old, you would have to hold that dose and question the order. If the doctor said just give it......you wouldn't. That is the same as standing your ground and NOT attempting first without sedation.
I would also point out to them the success rate is better without the wrestling match, the child is less traumatized with sedation, and less equipment and manpower is wasted with higher success rate. But mainly, it is inhumane to do that and if it were your kid would you let that happen? I have to agree with Heather about that approach too.
Gwen Irwin, Adult PICC Nurse that does some pediatric patients, but not the expert pediatric PICC nurse :)
Having just gotten wacked in the head by a sparkle wand in the hand of an 11 year old, I can sympathize! Actually for PICCs, we assess the child for veins first, and the pre-sedation NP comes around and assesses sedation needs/risk. We use some sort of sedation plus child life for almost everyone, except older kids that don't want any sedation, and neonates, who are often on fentanyl and versed infusions comcomitantly. We do mostly modified seldinger technique [micro-introducer] whcih is quite invasive, in my opinion, so we use the sedation plus local and do PICCs in IR suite or intensive care units at bedside. I have done PICCs in non-sedated kids and that is a bear!!! Although, I know Cincinnatti children's Darcy only uses child life except in the most recalcitrant children. Hope this is helpful....
Anne Marie Frey
Anne Marie Frey RN, BSN, CRNI, VA-BC Clinical Expert Vascular Access Service: I.V. Team The Children's Hospital of Philadelphia [email protected]