We currently place PICC's in patients down to the age of 12 even though we have not had any formal pediatric training. We have now been asked to go down to the age of 10. I am not a pediatric nurse and am concerned about the legality of placing PICC's in children without training. Can anyone tell me what we should specifically be concerned about? Is there an age or size that would be considered different than the adults?
Patty
I know the peds nurses will say this is an oversimplification but the only real difference is the growth and development issues and how you approach each age group. The actual insertion procedure is virtually the same. Anatomy and physiology is the same, although veins in infants and toddlers are smaller than older children. I have worked with policies stating an age or a weight for adult processes. For instance, fluid infusion management is done the same for adults and children weighing 100 pounds or more. Some school age children are the same actual size as adults. So it is the psychological approach that is tailored to each age group - neonates, infants, toddlers, preschool, school age, and adolescents. See the Peds chapter in the INS big textbook. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
If your facility is going to place PICCs in pedicatric patients, they either need a pediatric PICC RN.... or at the VERY LEAST get you pediatric trained. Children are not just 'small adults' as some people may suggest. Anatomy may be the same, but if you look at CXRs, you will notice that their cardiac sillouette is much higher in their chest than an adult, and are thusly measured differently. Lynn mentioned the developmental stages - they are important to KNOW.
There are many things we do for our peds patients that are not practiced with adults. We use topical lidocaine, buffered lidocaine, light sedation - heavy sedation sometimes, we have a staff of Child LIfe Specialists that prepare the patient for the procedure on a developmentally appropriate level, and support/distract during the procedure. Be prepared for screaming, kicking, wrestling, biting, bucking, pleading, and your sterile field being broken... sometimes even after sedation is given, and sometimes even with kids 10-12 y/o. After all, they are kids and they don't want to be stuck anymore-even if it is their last stick, or even if they get to go home!
Some folks have thought, if you can place PICCs on adults, you can place them on pediatrics as well, b/c, after all -they are just 'small adults'. At our facility we went through a period where we were to "crosstrain" adult and peds PICCs. Our adult PICC RNs are stellar at what they do, but pediatrics are a whole 'different animal'. They are experts in the adult world, and we are experts in the pediatric world, and we don't cross the street unless we are going to ASSIST each other. They do not place pediatric PICCs.
Our experience was that in order to be proficient and competent at placing peds PICCs, you should be placing them everyday.
Hope this helps!
Gretchen
Pediatric PICC Services
Children's Hospital @ OU Medical Center
I agree. Pediatrics can be challenging for the most proficient adult PICC nurse for the reasons mentioned and more.