Our pedi PICC team does over 90% of their patients awake without sedation. 9They do not do the NICU PICC insertions.) They typically use LMX4, but leave it in place for 2 hours. I know this is longer than the manufacturer recommendation, but through trial and error with pediatric patients, they found this to be the time period that allows them to insert PICCs, without the patient reacting at all! In fact, some of the pediatric patients (babies and very young) sleep through their PICC insertion.
They evaluate every patient (and parents) for the reaction to having a tourniquet in place. They also tune to the parents level of stress. They get some really good feedback about the child's reaction and their ability to tolerate a PICC while awake. Obviously, most of this is subjective, but they have been so RIGHT! The range of age that is most often sedated or anesthesized is under 2 years (but older than 8-9 months). These are the WILD ones. In that age range, if the patient is anesthesized for any other procedure, they will coordinate with anesthesia (and postpone, if necessary before insertion). They also use Child Life Specialists (they are invaluable) and value their assessment. We don't have very many pediatric outpatients, but the same assessment of the patient has consistently lead them to the right decision of sedation, anesthesia, or not. I have learned a lot from them. Gwen Irwin Austin, Texas ----- Original Message ----- From: "Pat Deisch" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Tuesday, February 21, 2006 10:25 AM Subject: pediatric PICC insertion and sedation > For those of you who place pediatric PICCs, > > 1) Do you give any sedation before placing a PICC? > > 2) If so, what type of sedation is typically ordered? > > 3) Do you have this on an order set for PICC insertion? > > 4) If the PICC is to be placed on an outpatient basis, would the > sedation ever be given at home before admitting the patient? > > Thank you so much in advance. > > Pat Deisch MSN, RN > BryanLGH Medical Center > Lincoln, NE 68516 > >
