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Modified Seldinger Technique with Ultrasound
for PICC Placement in the Pediatric Patient:
A Precise Advantage
Darcy Doellman, RN, BSN, CRNI, Inez Nichols, RN, CRNI, MSN
F
or pediatric patients requiring infusion therapy, several challenges (Tercan, Oguzkurt, Ozkna & Eker, 2008). These
challenges exist for the clinician who will be inserting challenges may include, but are not limited to, the ability to
a vascular access device (Lininger, 2003). Some of the successfully insert an appropriate size catheter (Tercan, Oguz-
challenges include the varied size and age range of the pediat- kurt, Ozkna & Eker, 2008) to meet the infusion requirements
ric patient. The age range of a pediatric patient is from 1 month of the patient and the patientʼs level of activity (Nichols &
of age to 18 years. Co-morbidities such as obesity or history of Doellman, 2007; NANN, 2007). Additional challenges include
prematurity have a direct effect on the size of the patient. the site of insertion, history of previous cannulation, and ex-
More than 90% of patients in hospitals have some form of perience of clinician (Tercan et al. 2008). Sedation or general
an intravenous (IV) device for their therapy (Infusion Nurses anesthesia may be necessary for a successful PICC placement
Society, 2006). Early identification of patients requiring short- procedure with infants and children (Ferguson & Costa, 2002;
term to intermediate-term therapy of IV medication makes Mickler, 2008; Schwengel et al. 2004).
for a more efficient and safer use of vascular access devices PICCs in the pediatric patient vary in size from 2 FR (French)
(Doellman, 2004; Moureau, 2006; Lininger, 2003). Peripher- to 5 FR. Catheter sizes 3 FR to 5 FR have traditionally required
ally Inserted Central Catheters (PICCs) have emerged as the large gauge (G) introducers (15 G – 19 G) for catheter place-
most commonly placed catheter for pediatric patients requir- ment. This traditional placement technique has most common-
ing infusion therapy in the hospital and homecare environment ly limited catheter sizes to 3 FR and 4 FR for pediatric patients
(Dubois et al. 2007; Gorski & Czaplewski, 2004). Factors such due to the larger gauge introducers being technically difficult to
as ease of insertion, reliability, and device comfort in addition insert into vessels similar in size to the introducer itself. Larger
to patient and staff satisfaction have led to the popularity of introducers induce tissue and vascular trauma that occur with
PICCs (Schwengel et al. 2004). unsuccessful attempts on patients with thrombocytopenia or
Criteria for pediatric PICC insertion include patients re- concurrent anticoagulation. These occurrences may increase
ceiving total parenteral nutrition (TPN), antibiotics, mainte- the likelihood of the inse