I would love to get some advice about current best practices for inserting 2 French PICCs. We are a pediatric sedation and vascular access service; mostly we insert 3 and 4 fr, but we attempt about 5-10 2 fr per year. At that low rate we haven't come to a consensus about what works best, so we thought we'd ask some more experienced providers.
For all other PICCs we use MST technique and ultrasound guidance, but for 2fr we still use tearaway introducers and mostly palpation at the antecube. I suspect this is a case of "That's how we've always done it," and we should push to use ultrasound and MST for our 2fr PICCs as well. But a brief review of available literature suggests that most neonatal PICCs are still inserted with tearaway introducers. The guidelines by NANN suggest that this is the most common method (although those guidelines have not been updated since 2007).
Does anyone have any thoughts on why 2 fr PICCS still tend to be inserted the "old-fashioned" way? Are there drawbacks to MST for neonates?
We'd also love to hear specific feedback on products you use. Particularly for ultrasound-guided PICCs. We find ours pretty lacking for small arms. Does anyone have a particular ultrasound unit or specialized small probe that they find particularly useful?