1. Teeny Tiny: 26 Gauge PIVCs in the Neonatal and Pediatric Populations Presenter: John O. Pilcher, BSN, RN, VA-BC, CRNI – Vascular Access Nurse, Boston Children's Hospital Co-Presenter: Kacey M. Wiseman, BSN, RN, CPN, VA-BC, CPUI – Vascular Access RN, Boston Children's Hospital
In pediatric vascular access it sometimes feels as if our patients, and their veins, are getting smaller and smaller. However, until recently the 24 gauge PIVC was our only peripheral option regardless of vein diameter. The development of a 26 gauge PIVC has created a viable and useful alternative to promote hemodilution. An initial trial was informative and addressed many of our questions and concerns around insertion and longevity. These catheters were placed using all our commonly employed modalities including transillumination, ultrasound guidance, and visualization/palpation. Our Vascular Access Team created tips and tricks for placement and worked together to overcome some initial setbacks successfully. We were also pleasantly surprised by features and results we had not expected. Limitations of the catheter will also be highlighted. Data from the trial and continued adoption of the 26 gauge PIVC will be compared to help highlight its place in the toolbox of the pediatric vascular access specialist.
2. Subjectivity in the SVC - Interpreting PICC Tip Location Presenter: Kacey M. Wiseman, BSN, RN, CPN, VA-BC, CPUI – Vascular Access RN, Boston Children's Hospital
This presentation provides a detailed examination of case studies that explore PICC placement and challenges with accurate identification of tip location in complex pediatric patients with anatomical variants. Cardiac anomalies, such as persistent left SVC, will be evaluated with potential associated risks and variations in clinical presentation. Further anatomical variants that resulted in catheter placement residing in collateral vessels will also be explored.
Describe two challenges and two advantages from placement of a 26 gauge PIVC.
Verbalize the populations, in their institution, most likely to benefit from the use of 26 gauge PIVCs.
Identify the major contraindication for infusing through a 26 gauge PIVC.
Describe anatomical variants of a persistent Left SVC.
Discuss challenges with accurate PICC tip location identification with anatomical variants.
Identify limitations for safe bedside PICC placement.
Examine landmarks for identifying abnormal PICC tip location on CXR.