Skip to Main Content

++

I. INDICATIONS

++

Percutaneous central venous catheterization (also called peripherally inserted central catheter [PICC]) involves inserting a long small-gauge catheter into a peripheral vein and threading it into a central venous location. The catheter is placed peripherally but is longer than the usual intravenous (IV) device, and hence its tip lies in a more central location. The catheter can be placed in large vessels such as the cephalic and basilic veins in the arm or the saphenous vein in the leg.

  1. When IV access is anticipated for an extended period of time.

  2. In low birthweight infants when it is anticipated that full enteral feedings will not be achieved within a short period.

  3. For the delivery of fluids, nutritional solutions, and medications when other venous access is not acceptable (eg, hypertonic IV solutions).

++

II. EQUIPMENT

++

  1. Basic supplies. Cap, mask, sterile gloves, a sterile gown, transparent dressing, and sterile tape strips (for stabilization of the catheter), a sterile tray (multipurpose tray or umbilical artery catheter tray), povidone-iodine solution or locally approved bactericidal skin prep, a sterile tourniquet (or a rubber band), saline flush solution, and a T-connector.

  2. Percutaneous catheter device. Two types of insertion devices are available: silastic (silicone) catheters (usually without introducer wire) and polyurethane catheters (usually with an introducer wire). Several sizes and double-lumen catheters are also available. National Association of Neonatal Nurses (NANN) guidelines recommend the following catheter sizes: infants <2500 g, 1.1–2F (28- to 23-gauge catheter); infants ≥2500 g, 1.9–3F (26- to 20-gauge catheter).

++

III. PROCEDURE

++

There are 2 commonly used types of catheters, and some of the smaller ones come with guide wires. The procedure varies if a guide wire is or is not present because the guide wire needs to be removed before blood is withdrawn or the catheter is flushed. It is suggested that the person placing the catheter should be familiar with the specific manufacturer's guidelines for placement of the catheters used. Special training is suggested before the placement of these devices. A review of the NANN Guideline for Peripherally Inserted Central Catheters (see Selected Reference) is also suggested and is helpful.

  1. Obtain informed consent and perform a time out. Gather the equipment and assemble the tray with the catheter using sterile technique.

  2. Select a suitable vein in the arm, such as the cephalic or basilic vein, or use the saphenous vein in the leg. (See Figure 43–1.) Position the infant so that the selected vessel is accessible. Restrain the infant to prevent contamination of the sterile field with the other extremities. It is helpful to have a second person available to help stabilize the infant's position, to help maintain sterility, and to offer a pacifier and comfort measures.

  3. Determine the length of the catheter. Measure the distance between the insertion site and the desired catheter tip location. (For catheters placed in the upper extremities, measure to the level of the superior vena cava or the right atrium; for catheters placed in the lower extremities, measure to ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.