Inserting central lines via the peripheral circulation in neonates

In preterm and sick full-term neonates safe intravenous (IV) access is vital for providing nutrition, medication, fluids, blood and blood products (Rocha et al, 2017). This article provides useful practice advice around using the modified Seldinger technique (MST) for neonatal peripherally inserted central catheter (PICC) insertions. Paying due attention to evidence-based practice and learning from other practitioners can reduce the inherent and potentially avoidable risks associated with the use of PICCs and thus increase patient safety and improve the patient experience.

There is considerable commercial choice of IV vascular access device (VAD) and consequently it is important to develop clear guidelines on device selection to ensure optimal clinical and economic use (Hugill, 2016). Decisions about which IV route (peripheral or central vein) and device to use are informed by patient and therapy factors such as weight, access (difficulty), duration of therapy and infusion characteristics. Figure 1 provides one example of a decisional flow chart that could be used to inform VAD selection. Its design is based on international standards (Mason-Wyckoff and Sharpe, 2015; Gorski et al, 2016) and local contexts such as product compatibility, hospital purchasing decisions and practitioner consensus.