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I need to do some research/information gathering... I need to know exactly what pediatric hospitals around the country are doing as far as sedation issues during PICC placement.  Several of you were kind enough to write and tell me of your sedation teams, but I think I'm going to need more information if I'm going to help make changes at this facility. 

I am having some HORRIFIC experiences with PICC line insertions.  The kids are not getting the kind of sedation they need, and it is a horrific experience for them as well. 

If you are a pediatric PICC RN, or your facility has one, I would like to contact them.  Please send the phone # or email address.  My email is [email protected]  spectralink is 405 271 0071

Thank you to anyone responding.... 

anna liang
the primary team who
the primary team who requests the PICC should be the one who decides if a patient needs min, mod, deep sedation or general. However, there is no clear guideline regarding who needs moderate or deep sedation. (it is a skill).
documenting failed PICC insertion related to inadequate sedation plan might be a start for you to advocate such service.
our 'true' sedation team was created about 2 years ago. Mainly thanks to JCAHO --a MD has to be there to titrate medication related to sedation.
pls feel free to page me @ 415-443-7492 sometimes next week.  
Leslie Gosey
We do not have a bedside

We do not have a bedside pediatric sedation team at our facility, although it is under consideration.

Currently I have 2 options for children who are not in an ICU; one dose of one agent at the bedside or take tham to the procedure room located in the operating room area where pediatric anesthesia staff will provide whatever level of sedation/anesthesia is required.

 The PICC RN will make the assessment for sedation need and then make necessary arrangements to implement the plan.  Assessment includes discussion with child/parents/nursing/childlife. Consideration must be given to the child's previous medical history/experiences, vessel condition, general temperament and age.  ALL of these factors will contribute to decision regarding specific sedation needs. It is impossible to make an all inclusive algorithm, each child has different issues and consequently we work out a plan to meet individual needs.

As a very general rule, infants up to 6-8 months can be done bedside. Older infants, toddlers and preschoolers generally are unable to cooperate with positioning and remaining still and require procedural sedation/anesthesia. Elementary aged children without a traumatic medical history will do fine at the bedside as will most middle to high school aged children.

For bedside placement we use LMX topical to site and 1% lidocaine local (working on getting buffered) The preferred anxiolytic is a dose of versed (if the child can take PO, oral versed works quite nicely).  Our child life team is excellent and works with the child reading books/singing songs/watching movies...whatever is necessary to keep the patient distracted from the procedure.  Parents are also welcome to stay( if they are comfortable).

I will bundle wrap babies to position them for the procedure. I do not strap down children or have others hold down children for the procedure.  That is not acceptable practice.  It does happen once in a while that we misjudge sedation needs and a bedside  procedure is stopped for failed sedation and the child scheduled for sedation in the OR. 

We are able to place lines in a safe, timely fashion (usually same day or next day) and our customers are quite satisfied with the experience.

Hope this is helpful to you! 

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