PICC Lines as well as their Use within the NICU

 

Peripherally Inserted Central Catheter (PICC line) Insertion

Video taken from the channel: Ajay Agade


 

PICC Line Assessment (Nursing Skills)

Video taken from the channel: NurseMinder


 

Pediatric Series (Video 1 of 3): PICC

Video taken from the channel: IR Education


 

Major Safety Milestone: NICU Achieves 3 Years with No Central Line Infections

Video taken from the channel: MedStar Washington Hospital Center


 

Neonatal PICC Insertion 2008

Video taken from the channel: Vascular Access


 

Inserting a PICC Line in a Premature Infant

Video taken from the channel: NeoConsult International


 

PICC Placement in the Neonate NEJM

Video taken from the channel: Pulmonary Resident Essentials


A PICC line is a long, soft, plastic tube inserted into a large vein in the baby’s arm or leg. 1  The line is guided up into a large vein near the heart where it can deliver medications such as antibiotics or chemotherapy) and/or total parental nutrition (TPN). The procedure for inserting a PICC line takes about 1 to 2 hours to complete. The PICC line should be visualized in either the left or right brachiocephalic vein using either the high frequency linear probe or the sector (cardiac) probe.

Remember that the brachiocephalic veins are relatively superficial (depth less than 2cm in most neonates) so minimal depth is required. Cardiac tamponade is a rare complication of PICC line use in neonatal units. It is a medical emergency, with associated morbidity and mortality. Literature suggests an incidence of 0.76% to 3% in infants with PICC lines.

Retrospective data from the UK estimate an incidence of 0.2%, with a. Peripherally inserted central catheters (PICCs) are pretty common in NICUs these days. As time has gone by, patterns have shifted in many units from having many people placing PICCs to dedicated teams. Although Peripherally Inserted Central Catheters (PICC) provide vascular access to newborns who require parenteral nutrition (PN) and medications, they can be associated with complications that lead to significant morbidity and mortality.

o Use the smallest catheter to complete the therapeutic goal (generally 3Fr PICC line is used to obtain laboratory samples and give blood products). o Place PICC line in lower extremities, preferably left leg. Right leg is used for heart catheterization. o If there are issues or. ices, policies, and providers in NICUs. Methods: The Neonatal PICC1 Survey was conducted through the use of the electronic mailing list of a national neonatal professional organization’s electronic membership community. Questions addressed PICC-related policies, monitoring, practices, and providers.

Descriptive statistics were used to assess results. Results: Of the 156 respondents accessing. Central Line Care PICC insertion in the neonate. The insertion of a longline should not be considered a routine.

However, infants who are VLBW, likely to be slow to reach full enteral feeds, have IV access problems or long term IV nutrition needs (NEC, major. CARE AND MAINTENANCE OF NEO-PICC PERIPHERALLY INSERTED CENTRAL CATHETER The Neo-Picc is designed for use when intermediate or long term IV administration is prescribed. Neo-Picc is intended for infusion of T.P.N., medications and IV fluids for neonatal and small pediatric patients.

To promote optimal functioning of the Neo-Pic. A PICC line is a thin, soft, long catheter that is inserted into a vein in the arm, leg or neck The tip of the catheter is positioned in a large vein that carries blood into the heart The PICC line is used for long-term intravenous antibiotics, nutrition or medications, and for blood draws Recommended for NICU patients for which IV therapy.

List of related literature:

PICC lines have been used for PN infusion both in the hospital and at home.

“Sleisenger and Fordtran's Gastrointestinal and Liver Disease E-Book: Pathophysiology, Diagnosis, Management” by Mark Feldman, MD, Lawrence S Friedman, MD, Lawrence J Brandt, MD
from Sleisenger and Fordtran’s Gastrointestinal and Liver Disease E-Book: Pathophysiology, Diagnosis, Management
by Mark Feldman, MD, Lawrence S Friedman, MD, Lawrence J Brandt, MD
Elsevier Health Sciences, 2020

Despite the popularity of the PICC line, we are still frequently asked to place central lines in the NICU.

“Fundamentals of Pediatric Surgery” by Peter Mattei
from Fundamentals of Pediatric Surgery
by Peter Mattei
Springer New York, 2011

Children also may have peripherally inserted central catheters (PICC lines) for therapy (Linck, Donze, & Hamvas, 2007).

“Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family” by Adele Pillitteri
from Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family
by Adele Pillitteri
Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010

The types of lines frequently used for infants in the NICU include umbilical venous catheters (UVCs), umbilical arterial catheters (UACs), and PICCs.

“Merenstein & Gardner's Handbook of Neonatal Intensive Care E-Book: An Interprofessional Approach” by Sandra Lee Gardner, Brian S. Carter, Mary I Enzman-Hines, Susan Niermeyer
from Merenstein & Gardner’s Handbook of Neonatal Intensive Care E-Book: An Interprofessional Approach
by Sandra Lee Gardner, Brian S. Carter, et. al.
Elsevier Health Sciences, 2020

the tubingfrom the IV system.It is generally preferable to use standard over-the-needle IV catheters whenever possible, whether for extremity or scalpIV lines, because they are less likely to infiltrate and will last longer.

“Clinical Procedures in Emergency Medicine” by James R. Roberts, Jerris R. Hedges
from Clinical Procedures in Emergency Medicine
by James R. Roberts, Jerris R. Hedges
Elsevier Health Sciences, 2009

PICC lines have the advantage that they can be placed at the bedside, often by a nurse rather than a surgeon or radiologist, but they typically do not last as long as the other catheter types.

“Hoffbrand's Essential Haematology” by A. Victor Hoffbrand, David P. Steensma
from Hoffbrand’s Essential Haematology
by A. Victor Hoffbrand, David P. Steensma
Wiley, 2019

PICC lines provide reliable central venous access in neonates and older children without the need for directly accessing the central veins.

“Holcomb and Ashcraft's Pediatric Surgery E-Book” by George W. Holcomb, J. Patrick Murphy, Shawn D. St Peter
from Holcomb and Ashcraft’s Pediatric Surgery E-Book
by George W. Holcomb, J. Patrick Murphy, Shawn D. St Peter
Elsevier Health Sciences, 2019

Although use of a PICC is only recommended for a few weeks, they can function successfully for many months and in some children at home on PN have been kept in situ for over 12 months.

“Textbook of Pediatric Gastroenterology, Hepatology and Nutrition: A Comprehensive Guide to Practice” by Stefano Guandalini, Anil Dhawan, David Branski
from Textbook of Pediatric Gastroenterology, Hepatology and Nutrition: A Comprehensive Guide to Practice
by Stefano Guandalini, Anil Dhawan, David Branski
Springer International Publishing, 2015

• Neonatal and paediatric PICC lines may require continuous infusions to maintain patency.

“Children in Intensive Care E-Book: A Survival Guide” by Joanna H Davies, Marilyn McDougall
from Children in Intensive Care E-Book: A Survival Guide
by Joanna H Davies, Marilyn McDougall
Elsevier Health Sciences, 2018

Other types of vascular access devices, such as central venous catheters and peripherally inserted central catheters (PICC lines), are not generally inserted by midwives.

“Skills for Midwifery Practice Australia & New Zealand edition” by Sara Bayes, Sally-Ann de-Vitry Smith, Robyn Maude
from Skills for Midwifery Practice Australia & New Zealand edition
by Sara Bayes, Sally-Ann de-Vitry Smith, Robyn Maude
Elsevier Health Sciences APAC, 2018

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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7 comments

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  • I am a paramedic and this is a terrible way to secure a PICC line in a premature baby. There was no indication of measurements going on, and the procedure was messy and unnecessary slow.

  • Good job, it was a successful procedure. What does a medic know about placing PICCs in neonates? No NICU ive worked in even employs a medic. there are many different techniques, but all in all it went in. Ive put in many neonatal PICCs and i take my time on the procedure. He was proper

  • Good but, to be frank, an incomplete demonstration. Measuring the line with a tape or some other way would be a very important thing to learn. Secondly, wasn’t there a guide wire to be removed?

  • I had a PICC line but, from the (perhaps inexperienced) flexation of the line by Nursing staff, it broke away at the external length. This then had to be recovered and a Hickman Line inserted which, by virtue of its complication, was the most distressing procedure I had to endure. PICC was not a “one stop shop” solution in my case. A decision to go Hickman directly would’ve been a better choice for patient comfort and stability.

  • Just wanting to give a WARNING on PICC lines, they should never be inserted into a person with total leg paralysis that only has their upper body for transfers. The transfer from wheelchair to bed is enough to severely damage the brachial plexus nerves, and cause permanent paralysis to the patients arm.

  • Just wanting to give a WARNING on PICC lines, they should never be
    inserted into a person with total leg paralysis that only has their
    upper body for transfers. The transfer from wheelchair to bed is enough
    to severely damage the brachial plexus nerves, and cause permanent
    paralysis to the patients arm.

  • Dear…as the name suggest peripherally inserted central catheter can be inserted through any peripherally vein…that is what makes it different from other central lines..any periphral vein can be used..this video shows a neonate and the picc is just 28 g..very very tiny as compared to those used in adults…the vein used is great sephanous vein…than you for your inputs