198 Section V ■ Vascular Access

b. Gather supplies. Wash hands thoroughly.

c. Identify appropriate vein for insertion (see D).

d. Position infant to facilitate insertion (Table 32.3).

Restrain infant; provide comfort measures.

e. Measure approximate distance from the insertion

site to the point where the catheter tip will be placed

(Table 32.3).

f. Don mask and head cover.

g. Set up/open sterile equipment tray.

h. Perform hand hygiene as for a major procedure and

wear sterile surgical gown and gloves.

i. Trim catheter to appropriate size (trimming is based

on unit policy and manufacturer recommendations).

The catheter is fragile and should be handled with

A B

C D

E F

Fig. 32.3. PICC using a peel-away cannula introducer. A: Perform venipuncture. When flashback of

blood is noted, reduce angle and advance introducer sheath farther to ensure placement in the vein.

B: Withdraw the introducer needle from the sheath. Note that the introducer sheath is supported to avoid

displacement. C: Insert the catheter into the introducer sheath using fine nontoothed forceps. D: Withdraw

the introducer sheath. Note that the catheter is stabilized by applying digital pressure to the vein distal to

the introducer sheath. E: Remove the introducer sheath by splitting and peeling it away from the catheter.

Complete catheter advancement to premeasured length. F: Aspirate catheter to check for blood return

and flush with heparinized saline to ensure patency. (From Klein C. NeoPicc: The Neonatal and Pediatric

Workshop Manual. San Antonio, TX: Klein Baker Medical, 1998, with permission.)

Fig. 32.4. Use of a blunt scalp vein needle to form a hub for a

silicone catheter. The plastic needle cover is used to stabilize the

needle–catheter junction. A commercially available blunt needle

adapter may be inserted and fixed in a similar manner.