Clinical Procedure
 
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If the PICC line snaps outside the skin it should be removed and another line inserted.
If this line was inserted in absolutely the last visible vein, rewiring the line after a thorough cleaning using a strictly aseptic technique is a possibility, although the risks and benefits should be discussed with the parents.
Consider discussing with the ID physician about whether a peri-procedural dose of an antibiotic might be prudent to reduce infection risk.
#paedcvad #spanza2012

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PICC lines carry a greater risk of migration than neck or thorax lines because of tip movement associated with arm abduction. Care must be taken to ensure that the catheter tip is correctly positioned at the time of their insertion with imaging. refl.in/9i

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Remember to release the torniquet before advancing either the wire or catheter.

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The risk of dvt in lower limb PICCs is likely to be too high to justify their routine use.
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Minimise fasting time and encourage intake of adequate fluids to optimise intravascular volume state
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Choosing a PICC line size for paediatric patients
< 10 kg 3 Fr
10 -50 kg 4 Fr
> 50 kg 5 Fr

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Aim to have the tip positioned 1 vetebral body below the carina on the chest xray.

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If the patient has a history of multiple previous lines consider performing an ontable venogram (call the radiologist or do it yourself if competent) to clarify the patient's venous anatomy.
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In the upper limbs, the basilic vein is preferable to the cephalic. The cephalic frequently has a sharp bend as it passes through the pectoral fascia that results in the wire or catheter snagging.

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Heparin-lock: 3 ml each lumen
Use 10 IU/ml if to be accessed within 6-24 hrs
Use 100 IU/ml if likely to be accessed after 24 hrs

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When you see the tip of the line at the desired spot, do a quick screen with the xray to look for flicking of the tip of the catheter. If this is occuring it means it is located within the RA and should be pulled back a little and rescreened until it stops flickering. #safety #LP

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