Training in Placement of Peripherally Inserted Central Catheters in the Neonate

Publication ID Published Volume
9780 April 24, 2014 10

Abstract

This is an instructional guide on the placement of a peripherally inserted central catheter (PICC) in an infant. This resource was developed following an iterative review process based on evidence-based practice published in the literature and on the expert experience of an interprofessional team consisting of neonatologists, neonatal-perinatal fellows, and neonatal nurse practitioner. The overall goals is to help those who place and maintain PICCs to standardize technique, improve success rates of PICC placement, and reduce PICC-associated complications.

This resource contains a 30-minute video that combines live footage of PICC placement in the clinical setting with slides, photos, and x-rays highlighting salient points of PICC placement not captured on the video. In addition, a procedural checklist, a self-assessment form, and a learner evaluation form are provided as supplementary materials to the video to enhance the learner’s training.

This activity has been successfully implemented for orientation, training, and maintenance of procedural certification of our neonatology doctors, nurse practitioners, and physician assistants over a 5 year period. Feedback from our learners and educators after implementation has been positive and included comments regarding the utility of this resource for postgraduate medical and nursing education and credentialing.

Citation

Butler-O'Hara M, Reininger A, Dadiz R. Training in placement of peripherally inserted central catheters in the neonate. MedEdPORTAL Publications. 2014;10:9780. http://doi.org/10.15766/mep_2374-8265.9780

Educational Objectives

By the end of this session, learners will be able to:

  1. Identify indications, contraindications, precautions, and potential complications of peripherally inserted central catheter (PICC) placement.
  2. Describe how to prepare for PICC placement, including the use of sterile technique and the identification of potential sites for placement.
  3. List the supplies needed for the procedure, including the different types of catheters and needles.
  4. Demonstrate how to successfully place a PICC while maintaining sterile technique.
  5. Describe methods for troubleshooting when encountering difficulty during the procedure.
  6. Determine correct radiographic positioning of the PICC.
  7. Demonstrate how to properly dress a PICC insertion site.

Keywords

  • Central Catheter, Catheters, Infant, Instructional Films and Videos

References

  1. Schulman J, Stricof R, Stevens TP, et al. (2009). Development of a statewide collaborative to decrease NICU central line-associated blood stream infection. Journal of Perinatology, 29(9), 591-599. http://dx.doi.org/10.1038/jp.2009.18
  2. Schulman J, Stricof R, Stevens TP, et al. (2011), Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics, 127(3), 436-444. http://dx.doi.org/10.1542/peds.2010-2873
  3. Stevens TP and Schulman J. (2012). Evidence-based approach to preventing central line-associated bloodstream infection in the NICU. Acta Paediatrica, 101 (464), 11-16. http://dx.doi.org/10.1111/j.1651-2227.2011.02547.x
  4. Butler-O’Hara M, D’Angio C, Hoey H, and Stevens TP. (2012). An evidence-based catheter bundle alters central venous catheter strategy in newborn infants. Journal Pediatrics, 160(6), 972-977. http://dx.doi.org/10.1016/j.jpeds.2011.12.004
  5. Wirtchafter DD, Pettit J, Kurtin P, et al. A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections. J Perinatol 2010;30(3):170-181. http://dx.doi.org/10.1038/jp.2009.172
  6. Bizzarro M, Sabo B, Noonan M, et al. A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infection Control Hospital Epidemiology 2010;31(3):241-248. http://dx.doi.org/10.1086/650448
  7. Chow LM, Friedman JN, Macarthur C, et al. Peripherally inserted central catheter fracture and embolization in the pediatric population. Journal of Pediatrics 2003;142(2): 141-144. http://dx.doi.org/10.1067/mpd.2003.67
  8. Wrightson DD. Peripherally inserted central catheter complications in neonates with upper versus lower extremity insertion sites. Adv Neonatal Care 2013;13(3):198-204. http://dx.doi.org/10.1097/ANC.0b013e31827e1d01
  9. Pettit J. Assessment of infants with peripherally inserted central catheters: part 1. Detecting the most frequently occurring complications. Adv Neonatal Care 2002;2(6):304-315. http://dx.doi.org/10.1053/adnc.2002.36826
  10. Pettit J. Assessment of infants with peripherally inserted central catheters: part 2. Detecting less frequently occurring complications. Adv Neonatal Care 2003;3(1):14-26. http://dx.doi.org/10.1053/adnc.2003.50011
  11. Shah PS, Shah VS. Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database System Review 2008;2:CD002772. http://dx.doi.org/10.1002/14651858.cd002772.pub3
  12. Paulson PR, Miller KM. Neonatal peripherally inserted central catheters: recommendations for prevention of insertion and post-insertion complications. Neonatal Network 2008;27(4):245-257. http://dx.doi.org/10.1891/0730-0832.27.4.245
  13. Pettit J, and Wyckoff M. Peripherally Inserted Central Catheters, Guideline for Practice, 2nd Edition. National Association Neonatal Nurses, 2007.

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ISSN 2374-8265