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Picc lines can be so frustrating, can't they? You insert a needle which appears to be nicely positioned within the vein, but no matter how hard you try the line just won't advance. Alternatively, you insert the line and secure it and tape it down and perform an X ray only to find that it's completely curled in a vein and it has to be withdrawn and all of your careful taping was for nothing. Whilst these are unfortunately occupational hazards in neonatal picc lines with experience and training, they will occur less frequently for you. I'm Doctor Matthew Sayers, a consultant pediatrician with over 10 years experience in pediatrics. And I have inserted a number of neonatal picc lines and experienced these same frustrations many times. In this video. I will share my tips and experience on how to safely and successfully insert a neonatal picc line so that you will have a better success rate. Links to all guidelines and documents in this video are available in the video description and on the a medical app pink stands for peripherally inserted central catheter. They are very important in the intensive care units for babies that require long term fluids and medications such as those on high risk feeding protocols and on pros MO QVC S are often easier to insert initially if the baby requires central access beyond the first few days of life. If a UVC cannot be inserted successfully or if the UVC needs to be removed due to Lyme infection, then a PICC line will be indicated. Strict aseptic non touch technique is required at all times when inserting and also when accessing a picc line, central line associated bacterial infection. Also known as clav C is a serious complication of line infection and will necessitate line removal and can cause sepsis and even death. So strict A N TT is required at all times. Always try and use a 24 gauge single lumen picc line where possible as this is wider and less prone to blocking if the baby requires multiple IV infusions, for example TPN and also prostin a double lumen picc line should be used if you have been unable to insert a 24 gauge picc line and the baby is less than 1000 g. Then a 28 gauge pre cap picc line can be used. However, this is not prepared as it is more prone to blocking and can only infuse a maximum infusion rate of 10 mils per hour. Assemble your equipment. You will need a sterile gown and gloves as this is a strictly A N TT procedure. A PIC line of suitable size for the weight and gestation of the baby sterile, normal sea line steri strips and an IV connector. AP pack contains the drapes, sterile swabs, forceps, tape measure and clear transparent dressings. Examine the baby for suitable insertion sites, preferred sites or visible veins in the antecubital fossa or the long safa vein. For arm lines measure from the insertion site to the sternal notch for leg lines measure from the insertion site to the umbilicus. If you are using the antecubital fossa, turn the baby's head towards the limb to reduce the risk of it entering the jugular vein, put down sterile drapes and clean the whole limb of the chosen insertion area. Allow to dry and place the limb through a clear plastic sterile field. Flush the picc line extension set and IV connector with sterile normalcy line. You can see there is a firm but delicate rod at the distal end of the PIC line carefully pull this through the blue plastic attachment so that it remains within the casing, but it is not poking through the distal end, attach the extension set and IV connector to the blue casing and flush with normal saline. Take great care not to fracture the rod. There are markings on the pic line at five centimeter intervals so that you are able to see how far you have inserted the pic line. Apply a tourniquet to the limb with only minimal tightness. Take care not to fully occlude the limb or damage the skin slowly and carefully insert the needle, introduce her into the vein. This is a large bore needle and may bleed significantly using the forceps and the P pack grip the top of the pic line and continually feed it through the introducer needle. There may be some resistance but it should advance reasonably freely. Flush the catheter with sterile normal sea line. As the lumen is very small. A one or 2.5 mL syringe may be easier for this. It should flush easily but may not be back due to the narrow lumen slowly and carefully remove the introducer needle from the skin and slowly slide it over the pic line, taking care to ensure that the P is not pulled out. If your introducer needle is off the splitting type, remove it carefully from within the skin and pull it apart on both sides. The needle will split in half which makes removal easier. There is often significant blood ooze following this procedure, gently apply pressure with a sterile swab from the pick pack. Be patient and don't apply the dressing until the ooze is fully stopped. Colistat swabs can be used if this is very excessive once the blood ooze has stopped and the area is very dry. Carefully. Apply steri strips over the insertion site gently and loosely coil the excess pic line around the insertion site, leaving a small amount of free line with the IV connector, apply the clear dressing over the area and flush to insert, take care not to inc a limb with the steri strip place a small amount of gauze under the IV connector to protect the skin and make sure there are no kinks in the picc line perform an X ray which includes the limb of the target insertion area. The tip of the PIC line should be visible in a large vein outside the heart with no loops or buckling, which suggests misplacement. If you are unable to confirm line position, a lino gram will have to be performed. Discuss this with the radiographer who will provide the contrast medium. The radiographer will position the baby an X ray and the doctor or nurse will inject the IV contrast via the PIC line. When directed to do so, do not give more than two mils per kilogram of IV. Contrast during this procedure, you must wear a lead apron to perform it and do not do it. If you think you might be pregnant, always remember to document the procedure and confirmation of position in the medical notes. Many units have performance to help you do this. If the picc line is not currently in use but is still required and you don't wish to remove it. Prescribe a naught 0.5 mil per hour infusion of normal or heparinized saline or else it will be prone to block and needs to be removed. Do not ever attempt to withdraw blood from an E nail picc line as it is to narrow lumen and will block. It should be flushed slowly using a 1 mL syringe without using excessive force. If it does appear to be blocked, first, confirm position on an X ray and check that there are no external kinks in the picc line using aseptic non touch technique, cautiously flush the line using one mil of 10 units per mil heparin I saline in a one ml Syringe do not use excessive force. And if this is unsuccessful, the PICC line will have to be removed. Picc lines can also migrate. So always make sure you check the line position on every X ray of the area the neonate has. If there are signs of lung dysfunction or you suspect migration, always x-ray the area to confirm it is still in position. Thanks so much for watching. Please like this video, comment with any clinical questions or feedback you have and subscribe to the channel and our other social media accounts including Instagram, Twitter, Med all and Ola to stay up to date with future videos. I look forward to seeing you again soon.