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Pediatric PICC placement

 We normally don't place Piccs on Pediatrics (18 or younger) at the bedside and they usually go to Interventional Radiology. Now questions are arising on why can't we place PICCs on older Pediatrics. So, what is a criteria for a Pediatric PICC placement in regards to age. Is there a cutoff age related to classifying them as Pediatric or is this vein size issue or combination of both. 

We use Sapiens to confirm, but is a Pediatric chest size going to be accurate. External measurements on a Pediatric, is this the same as Adults or different especially at certain ages. Before we look at changing things I would like feedback on possibly doing older pediatrics (12 and up). Thank you in advance for feedback...

Wendy Erickson RN
In general, there is no

In general, there is no difference between older children as you describe and adults.  In fact some teens will be bigger than some of the adults you place lines in!  We do place pediatric PICCs at the bedside, regardless of age.  But we do a full assessment first:  how does this child react to blood draws, IV starts?  Does the child have a suitable vessel to accommodate the size catheter we plan to use?  Will the child cooperate with us? 

Usually, their vessels are wonderful because they haven't had a lifetime of needle pokes.  (I am referring to kids in a general community hospital, not chronically ill children)  I encourage the use of a Peds/Child Life nurse to be in the room with you to help distract the child.  We try to use two PICC nurses for the procedure.  We explain briefly what will happen and then do it!  We have found using EMLA delays the procedure and gives the child time to REALLY get scared, and suddenly the veins are gone.  So we use buffered lidocaine.  I tell the child that they can watch TV, cry, hold hands, etc. but they HAVE to lie still.  If we don't think the child will be able to stay still and cooperate, we would refer them to IR and have the procedure done under some sedation by Anesthesia.  You will have some 5 year olds that lie perfectly still and some 16 year olds that need to be sedated!  That's why pre-assessment is so important.

You measure the same way as an adult.  If you are concerned about the Sapiens being accurate in a small chest, get an XRay post procedure to verify tip placement.  Hope this helps!

Wendy Erickson RN
Eau Claire WI

There is alot to read...

 There is a lot too read regarding this. 

Here is some:

Silastic catheters: pinpointing the end-tip of the catheter by means of elettrocardiographic monitoring. LG.Lozano, M.Barjau Capdevila. Rev Enferm 1997; 20 (230): 50-52

Central venous catheters no X-rays needed: a prospective study in 50 consecutive infants and children. MA. Hoffmann, JC.Langer, RH. Pearl et al. J Paediatr Anaesth 1999; 9: 501-504

Central venous placement in children: evaluation of elettrocardiography using j-wire. L.Simon, A.Teboul, N.Gwuinner, G.Boulay, S.Cerceau-Delaporte and J.Hamza. Paediatric Anesthesia 1999; 9: 501-504

Positioning of umbelical catheter with ECG-guided technique: randomized study. P.Biban, C.Cavalli, P.S

ECG guidance for CVC placement. Sebastian Shulz-Stubner MD. Anesthesia & Analgesia Aug. 2002; 95 (2): 502 (Letter to the editor)

Placing central venous catheters: gold standard for adult and silver standard for pediatric patients? A.Reich, M.Booke. Anesthesia & Analgesia sept. 2002; 93 (3): 785-786 


Nurse specialist ICU/ANE/PICC.

Dep. of Neurosurgery

Umea University Hospital/SWEDEN

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