sedation for a PICC line

Mommafirst · Dec 8, 2010

So Alyssa's PICC placement yesterday was a nightmare. When the PICC team set up the placement, they didn't plan on sedation. I insisted on something. They threatened that we might have to cancel and wait several days. Really?? I mean don't emergent procedures get sedation, or do all kids coming in for an emergency just have to be tortured??

I held strong and they brought in the sedation team. Sedation prepares one vial of nasal versed. I tell them that Alyssa had that last time and it didn't do anything. She still fought like crazy. If it doesn't calm her down it doesn't do any good.

No one listens to me. The assure me with the, "honey it'll be fine" or "this is how it has to be" bs. OK, I don't know what else to do, but trust them. I know she needs the PICC. So I consent.

One vial calms her down for about a minute. Once they start the procedure -- which includes cutting open her arm and shoving, with great pressure, the line in. She is thrashing and screaming, three of us are holding her down. I'm whispering in her ear, trying to calm her down. PICC nurse is getting annoyed that Alyssa won't lie still and Alyssa is screaming, "Please stop you are really hurting me." <img src="i/expressions/face-icon-small-sad.gif" border="0">

The give her another vial of the nasal versed. Again it doesnt' do anything. When they finally finish the placement she is a weeping mess. She can't stop crying and moaning about how much it hurts. They let her pick out a toy and she can't stand up.

When we got back to the room, she was crying her eyes out about how much it hurt and was scared of things that were clearly not in the room.

Eventually it all wore off and she can't remember a thing, but I'm traumatized by it. I KNEW that the nasal versed wouldn't work, and no one listened to me. I talked with our doctors, they were very empathetic and they are putting this all over her chart so that we can have a different plan for the future. But who knows what that would be, since I was pretty much told by sedation that this was our only option when I complained that it didn't work last time.

So what have you all done?? What works? Should I allow a deeper sedation -- maybe even full anesthesia for this? Alyssa has needed IVs about every 16 months or so, so I wouldn't consider that worthy of a port. The doctor did bring it up, but I'm not consenting unless her IVs become a lot more frequent.

I'd love any insight, experience or thoughts you have.

Thanks!!!

Heather

Mommafirst · Dec 8, 2010

So Alyssa's PICC placement yesterday was a nightmare. When the PICC team set up the placement, they didn't plan on sedation. I insisted on something. They threatened that we might have to cancel and wait several days. Really?? I mean don't emergent procedures get sedation, or do all kids coming in for an emergency just have to be tortured??

I held strong and they brought in the sedation team. Sedation prepares one vial of nasal versed. I tell them that Alyssa had that last time and it didn't do anything. She still fought like crazy. If it doesn't calm her down it doesn't do any good.

No one listens to me. The assure me with the, "honey it'll be fine" or "this is how it has to be" bs. OK, I don't know what else to do, but trust them. I know she needs the PICC. So I consent.

One vial calms her down for about a minute. Once they start the procedure -- which includes cutting open her arm and shoving, with great pressure, the line in. She is thrashing and screaming, three of us are holding her down. I'm whispering in her ear, trying to calm her down. PICC nurse is getting annoyed that Alyssa won't lie still and Alyssa is screaming, "Please stop you are really hurting me." <img src="i/expressions/face-icon-small-sad.gif" border="0">

The give her another vial of the nasal versed. Again it doesnt' do anything. When they finally finish the placement she is a weeping mess. She can't stop crying and moaning about how much it hurts. They let her pick out a toy and she can't stand up.

When we got back to the room, she was crying her eyes out about how much it hurt and was scared of things that were clearly not in the room.

Eventually it all wore off and she can't remember a thing, but I'm traumatized by it. I KNEW that the nasal versed wouldn't work, and no one listened to me. I talked with our doctors, they were very empathetic and they are putting this all over her chart so that we can have a different plan for the future. But who knows what that would be, since I was pretty much told by sedation that this was our only option when I complained that it didn't work last time.

So what have you all done?? What works? Should I allow a deeper sedation -- maybe even full anesthesia for this? Alyssa has needed IVs about every 16 months or so, so I wouldn't consider that worthy of a port. The doctor did bring it up, but I'm not consenting unless her IVs become a lot more frequent.

I'd love any insight, experience or thoughts you have.

Thanks!!!

Heather

Mommafirst · Dec 8, 2010

So Alyssa's PICC placement yesterday was a nightmare. When the PICC team set up the placement, they didn't plan on sedation. I insisted on something. They threatened that we might have to cancel and wait several days. Really?? I mean don't emergent procedures get sedation, or do all kids coming in for an emergency just have to be tortured??
 
 I held strong and they brought in the sedation team. Sedation prepares one vial of nasal versed. I tell them that Alyssa had that last time and it didn't do anything. She still fought like crazy. If it doesn't calm her down it doesn't do any good.
 
 No one listens to me. The assure me with the, "honey it'll be fine" or "this is how it has to be" bs. OK, I don't know what else to do, but trust them. I know she needs the PICC. So I consent.
 
 One vial calms her down for about a minute. Once they start the procedure -- which includes cutting open her arm and shoving, with great pressure, the line in. She is thrashing and screaming, three of us are holding her down. I'm whispering in her ear, trying to calm her down. PICC nurse is getting annoyed that Alyssa won't lie still and Alyssa is screaming, "Please stop you are really hurting me." <img src="i/expressions/face-icon-small-sad.gif" border="0">
 
 The give her another vial of the nasal versed. Again it doesnt' do anything. When they finally finish the placement she is a weeping mess. She can't stop crying and moaning about how much it hurts. They let her pick out a toy and she can't stand up.
 
 When we got back to the room, she was crying her eyes out about how much it hurt and was scared of things that were clearly not in the room.
 
 Eventually it all wore off and she can't remember a thing, but I'm traumatized by it. I KNEW that the nasal versed wouldn't work, and no one listened to me. I talked with our doctors, they were very empathetic and they are putting this all over her chart so that we can have a different plan for the future. But who knows what that would be, since I was pretty much told by sedation that this was our only option when I complained that it didn't work last time.
 
 So what have you all done?? What works? Should I allow a deeper sedation -- maybe even full anesthesia for this? Alyssa has needed IVs about every 16 months or so, so I wouldn't consider that worthy of a port. The doctor did bring it up, but I'm not consenting unless her IVs become a lot more frequent.
 
 I'd love any insight, experience or thoughts you have.
 
 Thanks!!!
 
 Heather

Ratatosk · Dec 8, 2010

What a HORRIBLE experience! I don't think DH would be very tolerant. He blasted an RT for not paying attention and cranking up the vest to 18 the day after DS's surgery, so I doubt he'd be putting up with something so horrifying as that. Ugh! I'd never heard of doing piccs without sedation until reading on this site and others.

When DS had his PICC put in at Children's, the anesthesiologist came in beforehand to see if we had any questions. Indicated he would be sedated, they'd use a mask with some sort of gas and that DS could choose the flavor. Then they'd put something in his IV. We went with DS into the room, DS picked orange, we held his hand as he fell asleep. I actually got a little woozy from it while I spoke to him as went to sleep. Off we went to the waiting room. The anesthesiologist came out a short while later, indicating he also changed out his iv in the other hand as it was looking angry. Went back up to the room, DS complained a little bit about his "broken arm" and that was it.

Unfortunately the next day he had to be sedated again for surgery for his bowel obstruction and he was concerned and he STILL mentions that "orange stuff".

Our only issue with his hospitalization was pain management. The nurses kept wanting to hold off giving him anything due to concerns with it slowing down his intestinal tract; however, his doctor still expected regular vest treatments and indicated they shouldn't short change him in terms of pain meds and further traumatize him.

Ratatosk · Dec 8, 2010

What a HORRIBLE experience! I don't think DH would be very tolerant. He blasted an RT for not paying attention and cranking up the vest to 18 the day after DS's surgery, so I doubt he'd be putting up with something so horrifying as that. Ugh! I'd never heard of doing piccs without sedation until reading on this site and others.

When DS had his PICC put in at Children's, the anesthesiologist came in beforehand to see if we had any questions. Indicated he would be sedated, they'd use a mask with some sort of gas and that DS could choose the flavor. Then they'd put something in his IV. We went with DS into the room, DS picked orange, we held his hand as he fell asleep. I actually got a little woozy from it while I spoke to him as went to sleep. Off we went to the waiting room. The anesthesiologist came out a short while later, indicating he also changed out his iv in the other hand as it was looking angry. Went back up to the room, DS complained a little bit about his "broken arm" and that was it.

Unfortunately the next day he had to be sedated again for surgery for his bowel obstruction and he was concerned and he STILL mentions that "orange stuff".

Our only issue with his hospitalization was pain management. The nurses kept wanting to hold off giving him anything due to concerns with it slowing down his intestinal tract; however, his doctor still expected regular vest treatments and indicated they shouldn't short change him in terms of pain meds and further traumatize him.

Ratatosk · Dec 8, 2010

What a HORRIBLE experience! I don't think DH would be very tolerant. He blasted an RT for not paying attention and cranking up the vest to 18 the day after DS's surgery, so I doubt he'd be putting up with something so horrifying as that. Ugh! I'd never heard of doing piccs without sedation until reading on this site and others.
 
 When DS had his PICC put in at Children's, the anesthesiologist came in beforehand to see if we had any questions. Indicated he would be sedated, they'd use a mask with some sort of gas and that DS could choose the flavor. Then they'd put something in his IV. We went with DS into the room, DS picked orange, we held his hand as he fell asleep. I actually got a little woozy from it while I spoke to him as went to sleep. Off we went to the waiting room. The anesthesiologist came out a short while later, indicating he also changed out his iv in the other hand as it was looking angry. Went back up to the room, DS complained a little bit about his "broken arm" and that was it.
 
 Unfortunately the next day he had to be sedated again for surgery for his bowel obstruction and he was concerned and he STILL mentions that "orange stuff".
 
 Our only issue with his hospitalization was pain management. The nurses kept wanting to hold off giving him anything due to concerns with it slowing down his intestinal tract; however, his doctor still expected regular vest treatments and indicated they shouldn't short change him in terms of pain meds and further traumatize him.

edan · Dec 8, 2010

Oh my gosh, I am so sorry you had to go through that. It brought tears to my eyes. At our hospital I believe it is standard to do light anesthesia at your daughter's age and a few years beyond that. My daughter was 3.5 when she had a picc and anesthesia was the rule. We had to be squeezed in between other proceedures since it wasn't planned and ended up having to wait 2 days as well becuase the schedule was so full. So they did IV antibiotics until then.

Sometimes I think a lot of the staff just doesn't get it. If this is a lifelong thing, why traumatize a kid? It isn't like this is going to be their only potential hospital stay. Why keep them on edge between visits wondering and worrying about the next one? My daughter still talks about how "wonderful" her "Doctor Hotel" stay was and wants to go back. maybe it is just because she is so young.

Thinking of you,

Edan.

edan · Dec 8, 2010

Oh my gosh, I am so sorry you had to go through that. It brought tears to my eyes. At our hospital I believe it is standard to do light anesthesia at your daughter's age and a few years beyond that. My daughter was 3.5 when she had a picc and anesthesia was the rule. We had to be squeezed in between other proceedures since it wasn't planned and ended up having to wait 2 days as well becuase the schedule was so full. So they did IV antibiotics until then.

Sometimes I think a lot of the staff just doesn't get it. If this is a lifelong thing, why traumatize a kid? It isn't like this is going to be their only potential hospital stay. Why keep them on edge between visits wondering and worrying about the next one? My daughter still talks about how "wonderful" her "Doctor Hotel" stay was and wants to go back. maybe it is just because she is so young.

Thinking of you,

Edan.

edan · Dec 8, 2010

Oh my gosh, I am so sorry you had to go through that. It brought tears to my eyes. At our hospital I believe it is standard to do light anesthesia at your daughter's age and a few years beyond that. My daughter was 3.5 when she had a picc and anesthesia was the rule. We had to be squeezed in between other proceedures since it wasn't planned and ended up having to wait 2 days as well becuase the schedule was so full. So they did IV antibiotics until then.
 
 Sometimes I think a lot of the staff just doesn't get it. If this is a lifelong thing, why traumatize a kid? It isn't like this is going to be their only potential hospital stay. Why keep them on edge between visits wondering and worrying about the next one? My daughter still talks about how "wonderful" her "Doctor Hotel" stay was and wants to go back. maybe it is just because she is so young.
 
 Thinking of you,
 
 Edan.

Rebjane · Dec 8, 2010

Heather,

I am sorry it was a bad experience. It will likely bother you for much longer than Alyssa.

Maggie had a PICC line when she was 2 1/2 years old and we had a similar "horrible experience". The plan was for her to have a bronchoscopy with anesthesia and the PICC line done at the same time. Unfortunately, we were admitted over the 4th of July weekend; it was terrible, new residents, holiday and we got the same"line" not enough staff to do the PICC while she had the bronch...So, they tried to do her PICC line while she was awake (she had already had the bronch) giving her a little ativan. Maggie was VERY cooperative but her veins were not. SHe got stuck over and over for 45 minutes...Finally I said that's enough; told them they were done. They had someone else stick her again over and over still not getting it in..

We had to stay an extra couple days and they had to do her PICC line by an interventional radiologist with more anesthesia and fluoroscopy; he got her first stick.

I made a complaint to the nurse manager, I was furious our original plan couldn't be met. She even called me when we got home, I must have caused quite a ruckus.

Anyway, Maggie's anatomy is just difficult to get an IV; they need a good line for the antibiotics that need to be given. So I guess they way for us to go is the interventional radiologist....I am not sure if the veins improve as they grow and get bigger; you would think so...The problem was definately not Maggie...Don't know many 2 years old who can hold out their arm without moving while awake for 45 minutes while getting stuck witha needle. Don't know if this info helps you but I can empathize!!!!

Rebjane · Dec 8, 2010

Heather,

I am sorry it was a bad experience. It will likely bother you for much longer than Alyssa.

Maggie had a PICC line when she was 2 1/2 years old and we had a similar "horrible experience". The plan was for her to have a bronchoscopy with anesthesia and the PICC line done at the same time. Unfortunately, we were admitted over the 4th of July weekend; it was terrible, new residents, holiday and we got the same"line" not enough staff to do the PICC while she had the bronch...So, they tried to do her PICC line while she was awake (she had already had the bronch) giving her a little ativan. Maggie was VERY cooperative but her veins were not. SHe got stuck over and over for 45 minutes...Finally I said that's enough; told them they were done. They had someone else stick her again over and over still not getting it in..

We had to stay an extra couple days and they had to do her PICC line by an interventional radiologist with more anesthesia and fluoroscopy; he got her first stick.

I made a complaint to the nurse manager, I was furious our original plan couldn't be met. She even called me when we got home, I must have caused quite a ruckus.

Anyway, Maggie's anatomy is just difficult to get an IV; they need a good line for the antibiotics that need to be given. So I guess they way for us to go is the interventional radiologist....I am not sure if the veins improve as they grow and get bigger; you would think so...The problem was definately not Maggie...Don't know many 2 years old who can hold out their arm without moving while awake for 45 minutes while getting stuck witha needle. Don't know if this info helps you but I can empathize!!!!

Rebjane · Dec 8, 2010

Heather,
 
 I am sorry it was a bad experience. It will likely bother you for much longer than Alyssa.
 
 Maggie had a PICC line when she was 2 1/2 years old and we had a similar "horrible experience". The plan was for her to have a bronchoscopy with anesthesia and the PICC line done at the same time. Unfortunately, we were admitted over the 4th of July weekend; it was terrible, new residents, holiday and we got the same"line" not enough staff to do the PICC while she had the bronch...So, they tried to do her PICC line while she was awake (she had already had the bronch) giving her a little ativan. Maggie was VERY cooperative but her veins were not. SHe got stuck over and over for 45 minutes...Finally I said that's enough; told them they were done. They had someone else stick her again over and over still not getting it in..
 
 We had to stay an extra couple days and they had to do her PICC line by an interventional radiologist with more anesthesia and fluoroscopy; he got her first stick.
 
 I made a complaint to the nurse manager, I was furious our original plan couldn't be met. She even called me when we got home, I must have caused quite a ruckus.
 
 Anyway, Maggie's anatomy is just difficult to get an IV; they need a good line for the antibiotics that need to be given. So I guess they way for us to go is the interventional radiologist....I am not sure if the veins improve as they grow and get bigger; you would think so...The problem was definately not Maggie...Don't know many 2 years old who can hold out their arm without moving while awake for 45 minutes while getting stuck witha needle. Don't know if this info helps you but I can empathize!!!!

mneville · Dec 8, 2010

Oh God! That is horrible especially since our kids usually go through it time and time again and Aidan remembers EVERY piece of it. Aidan has had 6 PICC lines but always gets anesthesia. It put him out for about 20 minutes while it is being put in. I feel so badly for you guys. Aidan always fights any kind of oral Versed and it doesn't work the way it's supposed to. Damn doctors not listening to you!

I would write a nasty letter to them; I don't think our kids should have to put up with that.
hopefully she feels better soon!
Megan

mneville · Dec 8, 2010

Oh God! That is horrible especially since our kids usually go through it time and time again and Aidan remembers EVERY piece of it. Aidan has had 6 PICC lines but always gets anesthesia. It put him out for about 20 minutes while it is being put in. I feel so badly for you guys. Aidan always fights any kind of oral Versed and it doesn't work the way it's supposed to. Damn doctors not listening to you!

I would write a nasty letter to them; I don't think our kids should have to put up with that.
hopefully she feels better soon!
Megan

mneville · Dec 8, 2010

Oh God! That is horrible especially since our kids usually go through it time and time again and Aidan remembers EVERY piece of it. Aidan has had 6 PICC lines but always gets anesthesia. It put him out for about 20 minutes while it is being put in. I feel so badly for you guys. Aidan always fights any kind of oral Versed and it doesn't work the way it's supposed to. Damn doctors not listening to you!
 
 I would write a nasty letter to them; I don't think our kids should have to put up with that.
 hopefully she feels better soon!
 Megan

SARAHSARAH253 · Dec 8, 2010

I'm soooo sorry...If I could hug you through the computer I would....I wanted to stop reading because it sounds so painful on both of you. Don't have any advise but hope you never have to go through that again. They should of done better for your little girl!

Love,

Sarah

SARAHSARAH253 · Dec 8, 2010

I'm soooo sorry...If I could hug you through the computer I would....I wanted to stop reading because it sounds so painful on both of you. Don't have any advise but hope you never have to go through that again. They should of done better for your little girl!

Love,

Sarah

SARAHSARAH253 · Dec 8, 2010

I'm soooo sorry...If I could hug you through the computer I would....I wanted to stop reading because it sounds so painful on both of you. Don't have any advise but hope you never have to go through that again. They should of done better for your little girl!
 
 Love,
 
 Sarah

mag6125 · Dec 8, 2010

I hate hearing how all your kids have to go through this everytime they have ivs. It just blows my mind because when I was young I just had a normal iv, even when I did meds at home, I never had my first PICC until I was about 12. I know the meds we use are hard on the veins and normal lines don't always last very long but I was just curious what kind of reasoning the docs give now for going straight to a PICC? Do they even give the option of a normal line anymore? I guess basically this all just makes me feel old. lol The only advice I can offer is it gets easier the older they get, I always had mine done with a local anesthesia and they use ultrasound to place it,of course by that age I'd had enough ivs that I prefered having a PICC placed to having a normal line. At the same time I've never had one put in at Children's because they didn't even do them there when I was younger, I've always gone to Akron General and they have amazing PICC nurses who still recognize me and my parents!

mag6125 · Dec 8, 2010

I hate hearing how all your kids have to go through this everytime they have ivs. It just blows my mind because when I was young I just had a normal iv, even when I did meds at home, I never had my first PICC until I was about 12. I know the meds we use are hard on the veins and normal lines don't always last very long but I was just curious what kind of reasoning the docs give now for going straight to a PICC? Do they even give the option of a normal line anymore? I guess basically this all just makes me feel old. lol The only advice I can offer is it gets easier the older they get, I always had mine done with a local anesthesia and they use ultrasound to place it,of course by that age I'd had enough ivs that I prefered having a PICC placed to having a normal line. At the same time I've never had one put in at Children's because they didn't even do them there when I was younger, I've always gone to Akron General and they have amazing PICC nurses who still recognize me and my parents!

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