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Thu, 08/16/2007 - 09:09

gretchen

looking for Pediatric advice...

I have been inserting PICCs in the pediatric population for about 3 months now (I placed neonatal prior). Â I am becoming frustrated with the manner in which I am to practice.Â I just want to know what everyone else out there is doing in reference to sedation and positioning.Â Do you use conscious sedation?Â How do you hold their arm still?Â Any special method?Â I just feel like I am getting an upper body workout everytime I do a line on a child ~18 months to early elementary school age.Â If you have any thoughts or suggestions, please respond!!!!

Thu, 08/16/2007 - 16:44

anna liang

we have a sedation team to

we have a sedation team to perform moderate sedation if a child needs it. primary MD requests/orders sedation service. recommendation also made by staffs, PICC RN & child life, usually based on pt's h/o copying skills related to painful procedures, such as PIVs/blood draws.

if you have to hold the arm still, e.g., failed sedation or the it is not safe to have sedeation, have an assistant use one hand to hold the should joint and the other the wrist.

for the age group you mention, sedation is indicated. Check with child life.

I have once done a picc for a 5 y.o. without sedation -- worse experience. it was heart breaking to see a 5 y.o. acting brave, holding still.

Thu, 08/16/2007 - 17:57

(Reply to #2) #3

gretchen

Anna: We do use child

Anna: We do use child life, we do use some sedation (99.9% of the time I have to ask/beg), and I do have someone hold the shoulder, and sometimes the shoulder and hand/wrist and someone else hold legs. We also 'burrito' wrap.

Sedation Team sounds great... who is that comprised of? RN's? Doc's?

Thu, 08/16/2007 - 21:37

(Reply to #3) #4

anna liang

for that age group you

for that age group you mentioned, if we still had to hold the kid down with sedation, we would charted as a failed sedation.

the sedation team has one RN & one attending. The attending directes the sedation -- titrate according to response and manage airway.

our experience for picc with sedation is that: don't start the picc until the kid is ready, especially for that age group.

if the kid does not 'jump'/'resist' with the tournique, very likely he/she is ready.

Mon, 08/27/2007 - 11:07

raye dillon

in our facility we do deep

in our facility we do deep sedation managed by a physician using diprivan or fentanyl and versed. the nurse does the picc and the doc is responsible for the sedation including the monitoring and recovery of the patient

Mon, 08/27/2007 - 15:27

Angela Lee

We also use a sedation

We also use a sedation service consisting of intensivist who administers Propofol and a sedation nurse who monitors the patient while we do the procedure. Every patient is evaluated on an individual need for sedation and we make the referral. Children in the early phase of admission (obviously the best time to PICC them) may be too sick to care but as they improve they feel good enough to resist. We may PICC a 2 year old at the bedside and sedate a 12 year old patient with high anxiety (or as it's referred to around here--high freak out titer-LOL). Very individual needs.

Fri, 08/31/2007 - 01:02

mmcerle1

gretchen: we sedate with

gretchen: we sedate with propofol as the other responses have indicated. Intensivist to administer and an RN to monitor and recover the patient. We scan the patients and apply EMLA one to two hours prior to the PICC placement. Along with the infusion, the intensivist gives 10 more of propofol just before we start the MST needle. I don't experience the child moving if I use EMLA as well as sedation. LMX does not work in my experience as well as EMLA. If no emla, I'd rather dot sedate at all.

Moira McErlean

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