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NeoReviews Vol.5 No.2 2004 e60
© 2004 American Academy of Pediatrics

Therapeutic Techniques

Peripherally Inserted Central Catheters in Neonates

^* Fellow, Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA

The first 300 words of the full text of this article appear below.

	Introduction

 
Peripherally inserted central catheters (PICCs) have become an increasingly common mode of treatment for neonates who require central venous access for more than a few days. The initiation of adequate parenteral nutrition, long-term antibiotic treatment, continuation of locally toxic medications such as dopamine, difficulty with repeated peripheral access, or the desire to remove umbilical catheters but still retain central access are a few common indications for PICC placement. Relative contraindications to PICCs include ongoing bacteremia, severe coagulopathy, and placement near a known thrombus. Following the insertion of PICCs, proper placement of the line should be ascertained, the line should be monitored carefully for potential problems, and inherent complications with this form of central access should be recognized early and addressed.

	Insertion Techniques and Positioning of Lines

 
After the indication for PICC placement has been verified, the appropriate vein for catheter insertion should be selected. Superficial veins used commonly for catheterization include basilic or cephalic veins in the upper extremities, temporal or posterior auricular veins in the head, and saphenous veins in the lower extremities. Occasionally, deep veins such as the axillary, femoral, popliteal, or external jugular vein have been used for PICC placement. The appropriate size and type of catheter must be selected; catheters most commonly are made of silicone or polyurethane.

The infant is positioned most easily with the arm abducted at a 90-degree angle and the head turned toward the arm of insertion. Often swaddling or pharmacologic analgesia/sedation is necessary. The catheter length is measured from an upper extremity insertion point to the midline of the sternum or if inserted from a lower extremity, to at least 2 cm above the umbilicus. Venipuncture is performed under sterile conditions, and the catheter is threaded slowly in 1-cm increments to reduce the risk of damaging the vessel, causing phlebitis, or positioning the catheter incorrectly. The introducer . . . [Full Text of this Article]

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