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Matt Remer
2 French PICCs

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?



We Can Do Better


It is the case of “this is how we have always done it” or “why change what works” I would also say comfort level.  As a former NICU nurse and Peds IV team nurse, when I started adults I couldn’t believe the difference in how things are done in vascular access. I took what I learn from adults and implemented it into my pediatric and neo patients and have found much success. NICU Nurses have told me they have zero BSI so they don’t want to change ANYTHING, I remind them its meticulous sterile technique is what gets us to zero.

There are clearly things we can do better for our tiniest patients such as using ultrasound, MST and standardizing dressing with securement devices. Yet,  I do understand the reservation. I was lucky enough to go to Puerto Rico and teach physicians these very techniques and they were not only successful but excited to move their practice forward. These patients deserve the same benefits from these technologies and techniques. Please feel free to email me to discuss further.

[email protected] 


Our team places quite a few 2

Our team places quite a few 2 FR catheters every month as we have a lot of infant consults. We utilize ultrasound for a venous stick with a 26 ga breakaway Neonatal introducer and feed the 2 FR (with stiffening stylet) through.  We try to stay away from ACs so as to not constrict the baby's movement.  We do not use MST for 2FR placements. 


holly hess
Matt, I completely agree with

Matt, I completely agree with Connie and have taken a similar path. I was a NICU nurse for 25 years and had placed a few hundred PICCs using the tearaway introducer. When I became a PICC nurse for pediatrics I learned MST and ultrasound and brought those methods to the NICU. Our team has taken over placing all NICU PICCs in our Level III unit and have used MST with U/S for over 3 years. We use it all the way down to the 500 gm babies. We eliminated the other introducers from our supply area and use 100% MST U/S. I do believe the resistance to change is just that, and I am trying to bring this change in practice to other hospitals. I have actually done some presentations at AVA and have submitted a speaking proposal for NANN for next year. I have also written a white paper on it.  I can ask the administrator of this site if it can be posted on the site. Also feel free to communicate via email.

Holly Hess

[email protected]

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