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Sedation for pediatric PICC insertion

I would like to hear from other hospitals regarding pediatric PICC insertions and what is used for sedation or not used .  How effective is the sedation.    We insert PICC's in our NICU, PICU and Peds ward.

Angela Lee
We use propofol  and it's

We use propofol  and it's very effective.  Sometimes patients still move even with local anesthetic (which you still have to use even with sedation) in a twitchy twisty way that propofol will not stop unless you want to intubate them.  Overall, it's a great way to manage toddlers and high anxiety kids who vasoconstrict when you look at them.  We do not sedate neonates.  We do not sedate every patient--it is a case by case decision.

In our NICU, we use

In our NICU, we use Fentanyl, 1 mcg per kg.  The rest of the Children's Hospital varies... I try to get Versed ordered if needed, and 99.9% of the time it is less than a conscious sedation dose so the doctors don't have to be present.  This is often not enough.  A lot of our patients could really benefit from conscious sedation.  I recently surveyed a number of Children's Hospitals on the very subject of sedation teams for PICC placement and found 12 / 13 hospitals have or have access to a sedation team for PICCs and procedures.  Pretty impressive, although I feel I am practicing in the dark ages. 

I recently gave a little inservice to the pediatric residents, and of course talked about sedation.  Since then, the residents have been better about ordering sedation.  But of course it is still less-than conscious sedation.  I do have to say that the Hem/Onc team is really good at coordinating their procedures using conscious sedation with ordering PICC lines.

I don't expect to make big changes fast, but I hope I can help improve the practice here little by little!

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