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tip placement in neonates and pediatrics

At the recent INS seminar in Lake Oswego, OR, one of the speakers mentioned that PICC tips are NOT placed in the SVC in neonates and young peds...I didn't get an opportunity to ask WHY NOT?!!  Thanks for any info.

Tanya Nauman RN, DRNI

lynncrni
I will definitely defer to

I will definitely defer to Janet Pettit, Anne Marie Frey, Angela Lee, and other neonatal/peds people, however, I think your speaker was wrong. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Angela Lee
PICC tips are definitely

PICC tips are definitely placed in the SVC.  Complications can occur with the catheter tip in the subclavian vein (which is where I assume the speaker suggested the tip be) or other vein just as in adults--occlusions, thrombus, pain, phlebitis,  leakage at site, and infiltration. 

The speaker may have been alluding to the fact that in premies and neonates there have been documented instances of vein or cardiac perforations if the tip is in a position to put continuous pressure on the vein or cardiac wall.  Also, with this population tip migration may be more common than with adults (however, I have no references at hand to speak to that although there are publications available).  Our NICU does weekly CXRs to verify stability of the tip.  Nevertheless, the incidence of these occurring would be greater with a tip anywhere other than the SVC (or IVC in the case of lower extremity placement).

I would certainly like to know where the speaker got her information.  It is this kind of misinformation that keeps nurses in a state of confusion and inadvertently promotes  suboptimal care for the patient. 

Ann Williams RN CRNI
When I first read your post,
When I first read your post, I wondered if the physician was referring to the IVC, as that is where we see a lot of tip placements in infants.  I notice Angela has already pointed this out.  Even if that is what he/she meant, it was poorly stated and will lead to a lot of misunderstanding.
T. Nauman RN, CRNI  IV

T. Nauman RN, CRNI  IV Educator SHMC Eugene, OR

No, they weren't talking about the IVC...they were basically wanting the PICC tip in the brachio-cephalic vein.  Our NICU PICC nurse says the neonatal docs don't want the tip in the "cardiac silhouette" which includes the SVC.  I  think they may be worried about cardiac perforation.  I'd like to find some recent articles about tip placement in neonates.  Does anyone know of any?

Thanks

T. Nauman RN, CRNI

lynncrni
Janet Pettit, a neonatal

Janet Pettit, a neonatal nurse practitioner is your best resource on this. Email her at [email protected]

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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