123 Evaluation of a Unique Pediatric Nurse-Inserted PICC Program

Concerns regarding safety and success of bedside PICC insertions in the pediatric population initially precluded the development of a nurse-inserted PICC program at our pediatric centre. All PICCs were inserted by interventional radiologists (IRs) under fluoroscopic guidance. We initiated a new nurse-inserted PICC program which is a collaboration between PICC nurses and IR.

Three nurses participated in the project. Patients who met pre-established selection criteria were selected. All insertions were performed using sterile technique on the fluoroscopy table with IRs available to support the PICC nurse. Veins were accessed visually or by palpation. Final tip position was confirmed in all cases with contrast and fluoroscopy. Additional fluoroscopy was only used if placement difficulties were encountered. All patients were followed prospectively.

Ninety-nine patients aged 3–18 years (average 13.4) met the selection criteria. Two patients had a primary insertion by an IR. The remaining 97 patients underwent an insertion attempt by a nurse. Sixty-nine PICCs were successfully placed by a nurse (71.1%), fifteen (15.5%) required minor assistance from a radiologist and thirteen (13.4%) were inserted by a radiologist after an unsuccessful nurse attempt. No insertion complications were noted. Insertion difficulties included difficulty advancing the catheter (19.6%), difficulty cannulating the vein (6.2%), and tip malposition (2.1%). Post-insertion complications occurred in 27.8% of PICCs, and 13.4% required removal prior to the end of therapy.

This novel pediatric nurse-inserted PICC program has a high safety profile, high success rate and low post-procedure complication rate.