How to place PICC lines in neonates

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Abstract:

PURPOSE: Peripherally inserted central catheters (PICC) are used extensively in neonates. However, insertion of these thinnest catheters is a very delicate procedure. We developed an easy and safe insertion technique for 2-French (F) PICCs with a new fine-tipped introducer cannula created without modifying commercial products by advancing a 24-gauge peripheral venous cannula through a half-peeled (20-gauge) introducer cannula. We evaluated neonates treated with our new PICC insertion technique.

METHODS: Information was collected retrospectively on all 32 2-F PICCs inserted during the 4-year period from November 2010 to November 2014. We monitored neonates, recording the success rate of placement, number of insertion attempts, reasons for removal, and complications.

RESULTS: In total, 32 2-F PICCs were placed in 31 patients (19 (61%) males and 12 (39%) females; median age 7 (range: 1-36) days, median weight 2200 (range: 800-4100) g) using the new technique. The vein accessed most commonly was the long saphenous vein (87%). The duration of catheterization was 10.3±4.2days. Almost all PICCs were inserted successfully (32/33, success rate 97%) and in the first venipuncture (28/32, 88%). Of the PICCs, 81% were removed after completion of therapy or upon death. Two minor bleeding complications were noted at the insertion site.

CONCLUSIONS: This novel technique is an easy and safe way of inserting a 2-F PICC in neonates. It can be used by anyone in a neonatal unit who can insert a 24-gauge peripheral venous access.

Reference:

Uygun, I. (2015) Peripherally inserted central catheter in neonates: A safe and easy insertion technique. Journal of Pediatric Surgery. August 15th. [epub ahead of print].

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