Name of the Procedure:

Insertion of Peripherally Inserted Central Venous Catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age.
Common Name(s): PICC Line Insertion for Infants

Summary

A PICC line insertion is a procedure where a long, thin tube (catheter) is placed into a large vein, usually in the arm, and guided towards a large vein near the heart. This description refers specifically to the procedure for children younger than five years old, done without imaging guidance.

Purpose

This procedure is commonly used for long-term medication administration, such as antibiotics or chemotherapy, nutritional support, or frequent blood draws. The goal is to provide reliable central venous access without the need for repeated needle sticks.

Indications

• Difficulties with peripheral venous access due to small veins.
• Need for long-term intravenous (IV) therapy.
• Administration of medications that can damage smaller, peripheral veins.
• Requiring frequent blood sampling.

Preparation

• Informed consent from parents or guardians.
• The patient might need to fast for a few hours if sedation is required.
• A physical examination and review of medical history.
• Possible blood tests or other diagnostic assessments.

Procedure Description

1. Preparation: The child is prepped in a sterile environment, and the insertion site is cleaned.
2. Sedation/Anesthesia: Depending on the child's age and anxiety level, local anesthesia or mild sedation may be administered.
3. Insertion: A small needle is used to access a vein, usually in the arm. The catheter is then threaded through the vein until it reaches a large vein near the heart.
4. Verification: The position of the catheter is checked manually without imaging guidance.
5. Securing: The catheter is secured with dressings and sometimes with sutures, to ensure it remains in place.

Duration

The procedure typically takes about 30 to 60 minutes, although preparation and post-procedure care might extend this time.

Setting

The procedure is usually performed in a hospital setting, either in a dedicated procedure room or at the patient's bedside in a pediatric ward.

Personnel

• Pediatrician or Pediatric Nurse specialized in PICC line insertions.
• Nurses for assisting with sedation and care.
• Anesthesiologist or Nurse Anesthetist if sedation or anesthesia is used.

Risks and Complications

• Common Risks: Minor bleeding, bruising, or discomfort at the insertion site.
• Rare Risks: Infection, catheter dislodgement, blockage of the catheter, or clot formation.
• Management of complications involves medications, catheter adjustment, or in rare cases, removal and reinsertion.

Benefits

• Reliable and sustained venous access for necessary treatments.
• Reduces the number of peripheral needle sticks.

• Minimizes discomfort for the child over time.

  Recovery

• Immediate post-procedure care includes monitoring for any signs of complications.
• Caregivers will be instructed on how to keep the site clean and what signs of infection to watch for.
• The child can resume normal activities relatively quickly, but rough play or activities that might dislodge the catheter should be avoided.
• Follow-up appointments will be scheduled to monitor the PICC line’s function and the child’s overall condition.

Alternatives

• Peripheral IV Lines: Short-term use but requires frequent changes.
• Central Venous Catheters: Similar to PICC but inserted into larger veins in chest or neck and often require imaging guidance.
• Subcutaneous Ports: Implanted devices for long-term access but involve more invasive surgery.

Patient Experience

• The child might feel a pinch or pressure during the initial needle insertion.
• Sedation helps minimize discomfort and anxiety during the procedure.
• Post-procedure, mild discomfort at the insertion site may be managed with pain relievers.
• Most children adapt quickly and can be comforted and distracted during the procedure by caregivers and healthcare staff.