Re: Neonatal (less than 90 days) patients with 2Fr PICCs
Does your Hospital send your neonatal patients home with 2Fr PICCs?
What concentration of Heparin Flush do you use for these patients?
What injection cap does your home care facility use?
Thanks
Moira Hudson McErlean
Pediatric Vascular Access Team
Rainbow Babies and Children's Hospital
We have sent home neonatal patients with PICCs and we send home toddlers with 2 Fr. PICCs. Most of the time everything goes smoothly ,occasionally there will be an occlusion or a dislodged catheter. The biggest concern to me is the experience of the home health nurse that is suppose to be a resource and help to the family. Often, the nurse is as intimidated by the small PICC and the small patient as the parents or even more so. Inaccurate information is given by the nurse which results in complications such as I've already mentioned.
Each case has to be individually assessed for parental competence and ability as well as desire to administer meds and take care of the PICC. Invested parents usually do well and end up teaching the home health nurse.
Angela Lee, BSN, CRNI
Children's health Systems
Birmingham, AL 35235
The OPAT guidelines has some language about pediatric cases and requires that these home care nurses have a peds background. This set of guidelines is published by IDSA. Here is the reference, although I am sure there is a newer one by now:
1. Tice A, rehm S, Dalovisio J, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. Clinical Infectious Diseases. 2004;38((15 June)):1651-1672.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I agree, the home care RNs need to be pediatric based. My question is about the heparin concentration and / or if a specific cap has helped prevent occlusions?
Moira McErlean
We use 10 unit Heparin lock concentration and we use positive displacement valves on all our PICCs. Sorry I wasn't more complete in answering your question.
Angela Lee
A recent study provided additional evidence about positive displacement needleless connectors and saline only flushing. The outcome was not good. As Angela said, they use heparin with these connectors. Here is the article:
1. Cesaro S, Tridello G, Cavaliere M, et al. Prospective, randomized trial of two different modalities of flushing central venous catheters in pediatric patients with cancer. J Clin Oncol. Apr 20 2009;27(12):2059-2065.
Hope it is helpful. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We will routinely send home neonates with 2 FR PICCs. Flushing is done every 8 hours with 1 ml of 10u/ml heparin flush.
With an experienced pediatric home infusion nurse and a family that has been thoroughly instructed in PICC care, we see very few complications.