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Peripherally Inserted Central Catheters And Midline Catheters In Children

AMBULATORY CARE:

What you need to know about peripherally inserted central catheters and midline catheters:

A catheter is a small tube used to give treatments and to take blood. A catheter can help protect your child's veins because medicine goes through the catheter instead of through the veins. The catheter is guided into place through a peripheral vein in your child's upper arm. Peripheral veins lead from your child's arms and legs to his or her heart. A peripherally inserted central catheter (PICC) is guided into a vein near the heart. A midline catheter is inserted into one of 3 veins in your child's arm. The end of a midline does not go past the top of your child's armpit.

How to prepare your child to have a catheter inserted:

  • Tell healthcare providers if your child is allergic to latex or has any other allergies. Tell them if your child had radiation or surgery on his or her chest, or any problems with a PICC or midline catheter. Also tell them if your child has ever had an allergic reaction to contrast liquid. Tell the provider if your child has ever had a reaction to anesthesia or other sedating medicine.
  • Talk to your healthcare provider about all medicines your child takes. He or she may need to stop taking certain medicines a few days before your procedure. Examples include aspirin, NSAIDs, and prescription blood thinners.
  • Your child may need treatment for medical problems, such as an infection or a bleeding condition. Your child's healthcare provider may use an ultrasound to find your child's veins. He or she will also make sure the veins are healthy enough for a catheter.
  • You may be told not to let your child eat or drink anything for about 6 hours before the procedure. Your child's healthcare provider will give you specific instructions to follow, depending on your child's age. The instructions will also include medicines your child can take or not take on the day of the procedure.

What will happen during the procedure:

  • Depending on your child's age, he or she may get general anesthesia or local anesthesia. General anesthesia will keep him or her asleep and free from pain during the procedure. Local anesthesia will numb the area. Your child will be awake during the procedure if local anesthesia is used. He or she may feel pressure or pushing during the procedure but should not feel pain. Talk to your child about how this procedure is done. Your child may be afraid of pain because a needle is used for this procedure. Explain how the medicine will help prevent pain.
  • A band will be tightened around your child's arm. This helps your child's healthcare provider see his or her veins. The band also stops blood from flowing into the vein while healthcare providers place the catheter.
  • Your child's healthcare provider will put a needle through your child's skin and into a vein. The provider may use an ultrasound or x-ray to place the catheter correctly. Have your child tell the provider if he or she feels pain or tingling while the catheter is being placed.
  • The needle and sheath (covering) will be removed, and the catheter will be left in the vein. Healthcare providers may secure the catheter to your child's skin with tape or stitches. A new bandage will be placed over the area to keep it clean and to help prevent infection.

What will happen after the procedure:

If your child has a PICC, a chest x-ray will be done to show healthcare providers the location of the catheter tip. Your child may be able to go home after the procedure. Have your child rest when he or she gets home. He or she should be able to go back to your normal activities the next day. Your child's healthcare provider will tell you which activities are okay for him or her. Do not let your child lift heavy objects. You will get instructions on how to care for your child's incision wound, and when it is okay to shower or bathe. This is usually after about 1 week.

Risks of having a PICC or midline catheter:

  • More than one attempt may be needed to place the catheter. The vein where the catheter is placed may become irritated, and your child's skin may get red, painful, and blister. When the catheter is put in, your child's vein may tear, or the catheter may injure a nerve. Your child's catheter may get blocked, and healthcare providers may need to remove or replace it.
  • The catheter may break, bend, or move out of place. The IV medicine may leak outside the vein and cause pain, swelling, or blisters. Your child can have bleeding, an allergy to heparin, or heparin-induced thrombocytopenia (HIT). HIT is a low number of blood platelets. This increases the risk of bleeding. Your child may get a blood clot in his or her arm. These problems can be life-threatening.

Seek care immediately if:

  • Your child feels pain in his or her arm, neck, shoulder, or chest.
  • The catheter site turns cold, changes color, or your child says he or she cannot feel it.
  • Your child coughs up blood.
  • You see blisters on the skin near the catheter site.

Contact your child's healthcare provider if:

  • Your child has a fever.
  • The catheter site is red, warm, painful, or oozing fluid.
  • You see blood on your child's bandage and the amount is increasing.
  • The veins in your child's neck or chest bulge.
  • You cannot flush your child's catheter, or your child feels pain when you flush the catheter.
  • You see that the catheter is getting shorter, or it falls out. Put pressure on the site with a clean towel before you contact your child's healthcare provider.
  • You see a hole or a crack in the catheter. Clamp your catheter above the damage before you contact your child's healthcare provider.
  • You have questions or concerns about your child's catheter.

Medicines:

  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child's healthcare provider.
  • Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin, salicylates, or oil of wintergreen.
  • Give your child's medicine as directed. Contact your child's healthcare provider if you think the medicine is not working as expected. Tell him or her if your child is allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs your child takes. Include the amounts, and when, how, and why they are taken. Bring the list or the medicines in their containers to follow-up visits. Carry your child's medicine list with you in case of an emergency.

Apply a warm compress as directed:

The area where the catheter was inserted may feel sore. A warm compress can help to decrease pain in your child's arm. Wet a small towel with warm water. Wring out the extra water. Wrap the cloth in plastic, and put it on the area. Use the compress 4 times a day, for 10 minutes each time. Prop your child's arm on pillows when he or she is sitting or lying down. This will decrease swelling.

Prevent catheter-associated infections:

The area around your child's catheter may get infected. Your child may get an infection in his or her bloodstream. A catheter-associated infection is caused by bacteria getting into your child's bloodstream through the catheter. Infections from catheters can lead to severe illness. The following are ways you can help prevent an infection:

  • Wash your hands and your child's hands often. Use soap or an alcohol-based hand rub. Clean your hands before and after you touch the catheter or the catheter site. Remind anyone who cares for your catheter to wash their hands.
    Handwashing
  • Wear medical gloves. Wear clean medical gloves when you touch your child's catheter or change bandages.
  • Limit contact with the catheter. Do not touch or handle the catheter unless you need to care for it. Do not pull, push on, or move the catheter when you clean your skin or change the bandage. Also remind your child not to touch the catheter or the area around it.
  • Clean your child's skin as directed. Clean the skin around the catheter every day and just before you change the bandage. Ask your healthcare provider what to use to clean your child's skin.
  • Check for signs of infection. Check your child's skin every day for signs of infection, such as pain, redness, swelling, and oozing. Contact your child's healthcare provider if you see these signs.
  • Cover the area. Keep a sterile bandage over the catheter site. Change the bandage as directed or when it is loose, wet, dirty, or falls off. Change your child's bandage in a place away from open windows, heating ducts, and fans. Be sure it is well-lit, clean, and free of dust. Clean the skin under the bandage with the solution your child's healthcare provider suggests. Let the area dry before you put on the new bandage.
  • Keep the area dry. Do not let your child's catheter or catheter site get wet. Wrap your child's arm with plastic and seal it with medical tape before he or she bathes. Ask if your child should take showers instead of baths. Do not let your child swim or soak in a hot tub.

Follow up with your child's healthcare provider as directed:

Write down your questions so you remember to ask them during your child's visits.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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