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Neonatal PICC line maintenance

Guide to PICC Maintenanc

Use the smallest catheter to complete the therapeutic goal (generally 3Fr PICC line is used to obtain laboratory samples and give blood products). Place PICC line in lower extremities, preferably left leg. Right leg is used for heart catheterization. If there are issues or questions consult with cardiothoracic surgeon The PICC is a very small gauge catheter (3-6FR), typically 50 to 60 cm in length, inserted percutaneously into an upper extremity vein and then threaded to the superior vena cava (SVC) or cavoatrial junction (CAJ)

MAINTENANCE Accurate placement is confirmed by x-ray every 2 weeks while the line is in place Consider removal if line is no longer in central position Dressing changes per PICC line dressing guideline Peripherally inserted central catheter A peripherally inserted central catheter (PICC) is a device inserted into a peripheral vein and threaded into the central venous circulation. Although PICC is the preferred term for this device, neonatal care pro-viders have historically referred to these catheters a

How to reduce bloodstream infection risk : Medical : 3M

Central Line Care - PICC insertion in the neonate. The insertion of a longline should not be considered a routine. However, infants who are VLBW, likely to be slow to reach full enteral feeds, have IV access problems or long term IV nutrition needs (NEC, major surgical problems etc.) may require line placement CENTRAL VENOUS CATHETER CARE AND MAINTENANCE GUIDELINE DRAFT CATHETERS CATHETER FLUSHING. DRESSING. REFLUX VALVE /CAP. BLOOD WITHDRAWAL. Catheters without valve, with external clamp (PICC & Tunneled) Example: • Cook . TM • Broviac . TM • When used intermittently, flush with: S - Saline . Adult: 5 ml . Pediatric/NICU: Amount needed t

Care Of Non-Vascular Percutaneous Catheter Policy: Purpose

Argyle™ Neonatal Peripherally Inserted Central Catheters (PICC Line) & Trays The Argyle™ PICC may be used to administer fluids for hydration and parenteral nutrition, as well as other common intravenous medications, in case where long term I.V administration is necessary standard for neonatal PICC insertions and PIVs. PICC post insertion complications are the lowest of all CVCs. 5. Complications can be avoided by using insertion and maintenance bundles, the proper device based on infant's weight and vein size, proper tip position, use of a securement device, and daily assessment of line function

Central Line Care - PICC insertion in the neonat

Neonatal PICC Line Peripherally Inserted Central

Use of PICC lines PICC lines should largely be reserved for use with TPN or other 24h infusions. Bolus drugs and those given by intermittent infusion should be given via a peripheral cannula whenever possible. Full aseptic technique should be used for insertion of PICC lines Use a midline catheter or peripherally inserted central catheter (PICC), instead of a short peripheral catheter, when the duration of IV therapy will likely exceed six days Purpose: The purpose of this study was to assess and describe the practices involved in the insertion and maintenance of peripherally inserted central catheters (PICCs) in neonates in level III neonatal intensive care units (NICUs) in the United States and to compare the findings with current recommendations and evidence. Subjects: The study included responses from 187 nurses, nurse. Medications administered intravenously in the neonatal intensive care unit (NICU) are often less than 3 mL in volume. However, guidelines from manufacturers of neonatal peripherally inserted central catheter (PICC) lines recommend the use of 5-mL syringes or larger to prevent potential rupture and/or fragmentation of the indwelling catheter because of high pressures. This article reviews [ Review major anatomical features of the neonatal vascular system. Identify steps of safe catheter insertion. Describe care and maintenance of catheters differentiating between polyurethane and silicone catheters. Recognize potential complications and risks associated with PICC lines. List the steps to take when removing the PICC catheter

You will need to care for the PICC, and for the skin around the catheter site. Proper care is important to prevent damage to the catheter, and to prevent infections. Change the bandage and injection caps every 3 to 7 days or as directed. Change the bandage any time it becomes wet, dirty, or moves out of place Peripherally Inserted Central Catheter (PICC) o Benefits • Long-term access - dwell time varies (can be > one year) • Decreased length of stay in hospital -allows for IV therapy in non-acute settings, i.e., home care /hospice/ skilled nursing facility (SNF) • Cost effective compared to all other central VAD

Neonatal Peripherally Inserted Central Catheter Practices

Explain neonatal care and maintenance procedures acceptable for use with PICCs including flushing and dressing changes Recognize potential complications associated with the use of PICCs Ultrasound is strongly recommended as a safety component of PICC insertion OBJECTIVE: To compare the rates of catheter-associated bloodstream infection (CABSI) in preterm infants born at <30 weeks' gestation who received a peripherally inserted central catheter (PICC) versus an umbilical venous catheter (UVC) immediately after birth as their primary venous access. METHODS: This retrospective matched cohort study examined data from infants born at <30 weeks.

the position of PICC line, whereas in 26% cases, a 2nd X-ray was needed. 5-7% of the babies needed more than 2 X-rays for final confirmation of PICC line position following adjustment and fixing. Though true line associated infection occurred only in 7 cases, total of 63 neonates had a positive culture [blood/CSF/urine] PICC lines also have a potential risk of air embolism and thrombosis. Types of PICC The preferred choice of line will depend on infant and PICC line factors. The following PICC lines may be used in RPA NICU: 1. Vygon silicone 24G (2F) single lumen 30cm: This is the preferred line for all infants not requiring a second lume Peripherally Inserted Central Catheter Lines: Information for Parents A peripherally inserted central catheter (PICC) is a very thin intravenous (IV) catheter that is inserted in a vein in the arm, leg, or scalp of an infant. A PICC line is used in infants who will need total IV nutrition or medication for more than 7 days For the above reasons, radiographs for PICC line placement should be taken with the infant's limbs in the position that they will be in for most of the day (see table 1). Arm abducted. Advances in neonatal care : official journal of the National Association of Neonatal Nurses. 2002;2(6):304-15 A PICC line is a long, soft, plastic tube inserted into a large vein in the baby's arm or leg. 1  The line is guided up into a large vein near the heart where it can deliver medications such as antibiotics or chemotherapy) and/or total parental nutrition (TPN). The procedure for inserting a PICC line takes about 1 to 2 hours to complete

Peripherally inserted central catheters (PICC Lines

Recommendations BSI Guidelines Library Infection

  1. PICC lines can differ in size (50 cm to 60 cm), the number of lumens (single to triple), and care and maintenance routines. Additionally, they can be valved or non-valved. Valved catheters prevent backflow of blood into the catheter when the system is open
  2. 1. Adv Neonatal Care. 2007 Jun;7(3):122-31. Technological advances for PICC placement and management. Pettit J(1). Author information: (1)Neonatal Intensive Care Unit, 1441 Florida Avenue, Doctors Medical Center, Modesto, CA 95354, USA. jspettit@sbcglobal.net Placement of a peripherally inserted central catheter (PICC) is often complicated by the infant's small size and previous use of the.
  3. es the type of infusions allowed. Exa
  4. Professional Healthcare, Inc. 3 of 4 I230 Responding to PICC Line Complications Response: This presents an area of much controversy. Some say many cases of sepsis can be resolved with the catheter in place; while others say that the catheter must be removed, the infection resolved and then another line can be placed. Others maintain the decisio

8. Remove central lines when 100 ml/kg/day of enteral feeds are reached or the central line is no longer needed. 9. A daily central line maintenance checklist for every central line (PICC, UVC, UAC, and surgically placed lines) willbe . completed and monitored monthly through surveillance by the PICC RN team Neonatal intensive care units (NICUs) commonly utilize peripherally inserted central catheters (PICCs) to provide nutrition and long-term medications to premature and full-term infants. However, little is known about PICC practices in these settings Sharpe et al (2016). Abstract: BACKGROUND: Neonatal intensive care units (NICUs) commonly utilize peripherally inserted central catheters.

A national survey of neonatal peripherally inserted

  1. You have a fever or swelling, redness, pain, or pus where the catheter was inserted. You cannot flush your catheter, or you feel pain when you flush your catheter. You see a tear in the tubing of your catheter. You see fluid leaking from the insertion site. You have questions or concerns about your condition or care. Care Agreemen
  2. Proficiency in IV insertion will not guarantee that a PICC insertion will be easier, but without the IV skills, insertion of PICCs in neonates will be less successful. Like any other procedure, PICC line placement requires patience and practice. The methodology I use has been refined over the 25 years I have been doing this in the NICU
  3. Neonatal/Pediatric PICC and Midline Catheters. Argon Neonatal/Pediatric PICC and Midline catheters are designed specifically for this patient population. Catheters come in a choice of silicone material or polyurethane material. The option for safety and non-safety introducers is designed to enhance first-stick proficiency
  4. Fast Facts About the Peripherally Inserted Central Catheter (PICC) The PICC is a long, soft, flexible catheter (CATH-it-er) or tube that is placed in a vein in the arm for long-term use. The use of X-rays is needed during positioning of the PICC. The procedure to place the PICC can take about 1 to 1 1/2 hours
  5. IV: PICC Line. The PICC (Peripherally Inserted Central Catheter) line is a plastic tube that is inserted into a large vein to give intravenous (IV) therapy. This catheter is used when IV therapy will be needed for a long time or when the small veins in the body can no longer be used for IV therapy
  6. They speculated that the success achieved in this cohort with the longest duration of exposure to the PICC team highlighted the importance of standardized line maintenance by a select few. 13. Holzmann-Pazgal et al. 12 investigated the impact of implementation of a dedicated central line maintenance team in a 118-bed NICU. Prior to establishing.

Keeping PICC lines ready. Care and maintenance of a PICC line includes assessing the site for signs and symptoms of infection, including redness, tenderness, or swelling. To keep an eye on any swelling, the patient's arm circumference can be compared with the baseline measurement taken before PICC line insertion The StatLock™ PICC Universal Neonate Stabilization Device offers gentle securement on neonatal skin. Designed to minimize catheter motion and reduce complications while increasing patient comfort. The StatLock™ PICC Universal Neonate Stabilization Device is simple, safe and effective Adv Neonatal Care Neonatal intensive care units (NICUs) commonly utilize peripherally inserted central catheters (PICCs) to provide nutrition and long-term medications to premature and full-term infants. However, little is known about PICC practices in these settings A peripherally inserted central catheter (PICC) is a type of CVC. While beneficial, central line associated bloodstream infection (CLABSI) is a risk for patients having a CVC inserted. Antiseptics are used for skin preparation when inserting a central line to prevent infection and during maintenance of the central line

Evaluation of practice: Small-volume intravenous

  1. Neonatal Skin Care Evidence-Based Clinical Practice Guideline, 4th Edition. Newborn skin care practices have the potential to impact skin for many years. This revised guideline is targeted to obstetric, postpartum, and neonatal nurses, and other healthcare providers caring for newborns in various settings
  2. istration of medications. The risk/benefit ratio of placement and duration.
  3. Safe dressing techniques for neonatal peripherally inserted central catheters (PICCs) remain controversial in the literature. This article describes one unit's experience with the placement and management of 491 PICCs during a six-year period with more than 5,600 catheter days
  4. This article describes one neonatal intensive care unit's experience in response to that need, as they formed a dedicated neonatal peripherally inserted central catheter team. In addition, strategies for ongoing maintenance and continued success of the peripherally inserted central catheter program are discussed
  5. Background The improper handling of a peripherally inserted central catheter (PICC) in newborns (NBs) may result in mechanical and infectious complications. Aim The aim of this systematic review (SR) is to estimate the prevalence of complications associated with the use of PICC in NBs. Methods We will utilize PubMed, Embase, CENTRAL, Web of Science, Scopus, Cochrane Library, CINAHL, and Google.
  6. Background. Late-onset neonatal infection is a major cause of mortality, prolonged hospitalisation and increased hospital costs for neonatal intensive care unit (NICU) patients1 and is associated with increased risk of neurodevelopmental impairment and cerebral palsy.2, 3 Extremely premature neonates have a high risk of infection due to biological immaturity,4, 5 frequent invasive procedures.
  7. The incidence of the commonest PICC-RC, PLE (seven of 10), was 0.09 per 1000 catheter days. No PICC related pericardial effusion was identified. All except one PICC catheter tip was located in a central position at time of insertion (catheter tip T3-T7 inserted from upper limb [UL]/scalp or tip T9 to L1-L2/L3-L5 from lower limb [LL])

Neonatal Vascular Access - Cardinal Healt

started. The catheter position is confirmed by X - ray (10). Umbilical catheterization is performed by a physican in sterile gown and gloves and with a nurse assisting, while PICC insertion is most commonly performed by a specialized PICC nurse. Maintenance The catheter should be manipulated as little as possible. The site of insertion i cated central line maintenance team in the NICU is essential to the improvement of CLABSI rates. 4 FIGURE 1 Compliance with line rounding. AON, All Or Nothing Principle; NICU, neonatal intensive care unit central line; PICC, percutaneous inserted central catheter. ANC-D-15-00048.indd 2 19/04/16 4:15 A PURPOSE: The purpose of this study was to assess and describe the practices involved in the insertion and maintenance of peripherally inserted central catheters (PICCs) in neonates in level III neonatal intensive care units (NICUs) in the United States and to compare the findings with current recommendations and evidence A PICC line gives your doctor access to the large central veins near the heart. It's generally used to give medications or liquid nutrition. A PICC line can help avoid the pain of frequent needle sticks and reduce the risk of irritation to the smaller veins in your arms.. A PICC line requires careful care and monitoring for complications, including infection and blood clots

Infection control in icu

Many Neonatal PICC Lines Migrate 24 Hours After Insertion. CHICAGO - A full 45% of all peripherally inserted central catheter lines placed in the basilic or cephalic veins migrated 24 hours after insertion in a retrospective analysis of 100 consecutive lines placed in a neonatal intensive care unit. Of the 76 peripherally inserted central. Start typing, then use the up and down arrows to select an option from the list. Depending on the user selection user can also view top products related to the selection The PICCs are 1.9fr, mostly single lumens. In the past at other places, I have run .5ml/hr with 0.5-1 unit of heparin per ml (into a 1.9fr double lumen PICC). The first place I ever worked did not run continuous fluids and flushed q8h with 2ml of NS containing 2 units of heparin per ml (into 2fr PICCs) Services include PICC Line and Midline insertions, and Vascular Access care and troubleshooting interventions. Click here for more info on our mobile PICC and IV Team. Upcoming Events. PICC and Midline Insertion Class (Session1, Basics) Tue, Jul 13, 2021 9:00am - 6:05pm @ PICC Resource Office, Shelton, CT

PICC-Nate® is a peripherally inserted central catheter (PICC) specially designed to avoid irritating the baby's delicate tissues during neonatal vascular access. PICC-Nate® Vascular Access Catheters and Introducers are specifically designed to minimize trauma to the neonatal patient and are available in a variety of kit configurations, in. The actual line itself is secured to the skin with steri-strips, NEVER tape. Then we cover w/ tegaderm. Our dressings are changed on a PRN basis. As for removal of the PICC, we as RN's are allowed to remove them unless it was a cut down PICC line, in which case either the NNP or MD removes it Starboard Medical's line of engineered stabilization devices, Clik-FIX™, will be showcased at the event in Exhibit Hall Booth #618. The company will introduce its newest development the Clik-FIX Neonatal PICC Securement Device. Like all Starboard's securement products, the Neonatal PICC Securement Device was designed with patient care in.

How to Care for your Picc (Peripherally Inserted Central

Neonatal intensive care is extremely expensive causing financial burden both on the family and the health care system. The global neonatal peripherally inserted central venous catheter market can be segmented based on type of PICC, end-user, and region A peripherally inserted central catheter, also known as a PICC (pronounced pick), is just one type of central venous catheter. While a PICC is never used for dialysis, it is commonly used to administer medications for patients, such as antibiotics or chemotherapy. Let's look at the similarities and differences between a CVC and a PICC. A peripherally inserted central catheter can stay in a patient's body 30 days or longer. Does Health Line offer a neonatal PICC line? Yes, our Bantam™ 1.9Fr PICC line kit is designed for neonatal patients Daily Checklist for Central Line Maintenance. See Attachment 1. Back to Table of Contents. Infusions should be given via central or Percutaneous Intravenous Central Catheter (PICC) line as they can cause extensive tissue sloughing if extravasation occurs (infusion may commence in a peripheral line until the blood pressure improves to.

PICC lines are used extensively in the neonatal population. In most facilities, the majority of infants weighing less than 1000 grams and at less than 28 weeks gestation will have at least one, and in some cases several, PICC lines throughout their hospital stay. The direct introducer metho PICC Care. A PICC is a peripherally inserted central catheter. This special IV is placed into a large vein in the upper arm and sometimes in the leg of an infant. The end of the PICC ends in a vein close to the heart but not in the heart. The PICC can stay in place for several months. The PICC can be a single or double lumen line 1.3. Non-central catheter tip position associated with complications When the tip of PICC is not at the superior or inferior vena cava, it is called non central catheter tip position. The mid-clavicular tip position of central lines is more commonly associated with line infiltrations.4 In a study by Jain et al,4 non-central PICCs developed mor

Astodia - FUTUREMED

Care & Maintenance Bundle - Leader in PICC Line

maintenance of Central Venous Lines (CVL) and Peripherally Inserted Central Catheters (PICC). Bundle implementation was supported by extensive education. The Bundle elements: • Daily evaluation of the necessity of the central line • Chlorhexidine gluconate (CHG) scrub for all central line insertions in neonates ≥26 weeks of age PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) A Peripherally Inserted Central Catheter (PICC) is a small gauge catheter that is inserted peripherally but the tip sits in the central venous circulation in the lower 1/3 of the superior vena cava. It is suitable for long term use and there are no restrictions for age, or gender. Locatio The Neo♥PICC® catheter has a skin reference marking. This O marking should be at the skin entrance site. This will leave 3cm. of catheter tubing exposed externally, which should decrease the chance of skin erosion, pistoning of the catheter at the entrance site, and catheter kinking. 5. Set up the sterile field. • Don face mas Powers R J, Wirtschafter DW. Decreasing central line associated bloodstream infection in neonatal intensive care. Clin Perinatol 2010, 37, 247-272. IV 13. Linck D, Donze A, Hamvas A. Neonatal Peripherally Inserted Central Catheter Team. Advances in Neonatal Care 2007, 7(1), 22-29. I Collaborative of North Carolina (PQCNC), implemented a national, neonatal central line-associated bloodstream infection (NCLABSI) reduction project specifically focused in Neonatal Intensive Care Units (NICU). CLABSI is a significant contributor to morbidity and mortality for infants

Neonatal PICC line insertion - YouTub

  1. PICC Line. The PICC line is a thin tube that is inserted into a vein in order to give medicine and fluids directly into the infant's bloodstream. It is used if a baby needs to be given medicine, blood or fluids many times over several days, weeks or months
  2. istration • Heparin 100 units/cc 2.5cc final flush in absence of continuous infusion and daily when line not in use
  3. NEONATAL SERVICES DIVISION Approved by Quality & Patient Care Committee July 2018 PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) - INSERTION This Local Operating Procedure is developed to guide safe clinical practice in Newborn Care Centre (NCC) at The Royal Hospital for Women
  4. Objectives: To describe the characteristics of pleural effusion (PLE) associated with PICC use in a large level III neonatal intensive care unit. Design/Methods: A retrospective review of PICC-related PLE in newborns was conducted over a 5-year period, from 2008-2012. Results: A total of 926 PICCs were inserted, accounting for 17,606 catheter.

This video demonstrates the placement of a peripherally inserted central catheter (PICC) in a neonate. Funding and Disclosures Disclosure forms provided by the authors are available with the full. PICC certified RN's are the only persons approved to change central line dressings. PURPOSE: To provide regular, standardized catheter site care; to apply a sterile, clear occlusive dressing Central VAD Care and Maintenance: Flushing Always use a 10ml or larger syringe to flush or administer medications. Smaller syringes have increased flushing pressure that cause catheter rupture. Note: some pre-filled syringes smaller than 10ml have syringe barrel equal to a 10 ml syringe and are acceptable to us Background and Objectives: The placement of a peripherally inserted central venous catheter (PICC) is an es-sential procedure in neonatal intensive care units (NICU). The aim of this study was to determine the risk of PICC complications in NICU, and further identify the effects of PICC complications on body weight gain in premature infants Part 6 PICC Vascular Access Policy - Andrew Barton- January 2019 Version 3. 1. In line with national guidance the PICC tip should be below the carina and at or above the cavo-atrial junction. 2. If the patient has an absent 'P' wave on their ECG a chest x-ray will be required to confirm tip placement 3

Analysis of risk factors of PICC-related bloodstream

Peripherally Inserted Central Catheter (PICC) Insertion, Including Modified Seldinger Technique Effective Date: I. Purpose To provide policies and procedures specific to the NICU RN PICC Team members and neonatal physicians for the insertion of a PICC line. II. Presumes Knowledge: WNH Standard Policy Statements. WNH I.1 Infant Identification The NeoMagic® line of neonatal vascular access devices, PICC catheters and other accessories are designed specifically for neonatal patients. At Neo Medical Inc., we specialize in products for neonatal patients. Our NeoMagic ® line of products includes neonatal PICC catheters, EPIVs, MSTs, introducers and accessories

Neonatal PICC Qualification Training Progra

Utilizing a line maintenance team to reduce central-line-associated bloodstream infections in a neonatal intensive care unit. J Perinatol 2012; 32 : 281-286. CAS Article Google Schola St. Louis, MO: Elsevier Saunders. Kallen, A. (2009). Central line-associated bloodstream infections (clabsi) in non-intensive care unit (non-icu) settings toolkit. Atlanta, GA: Centers for Disease Control and Prevention. Stacey, K.M. (2014). Peripherally inserted central catheter (picc): Maintenance and dressing change quicksheet A total of 87 neonates in a tertiary neonatal intensive care unit in Hunan Province were integrated into practice of PICC to evaluate the incidence of catheter-related complications and one-attempt success rate of puncture. Results: The results of Meta-analysis showed that the incidence of complications of PICC in neonates via lower limb veins.

Risk of Infection Using Peripherally Inserted Central and

The PICC team was established in July 2007. Once the two PICC nurses were hired and trained, a central line insertion and maintenance protocol was developed by the PICC team members, NICU leadership, Infection Control, and Neonatology Guidelines for Care of a Peripherally Inserted Central Catheter (PICC) by Community Staff November 2016 To Prevent Movement ensure the S- ecurAcath securing device is in place at all times. It does not require removing and replacing and can remain in situ for the life of the PICC. The catheter can move out up to 3cm before a chest X-ray is. Sharpe E , Kuhn L , Ratz D , Krein SL , Chopra V . Neonatal peripherally inserted central catheter practises and providers: Results from the neonatal PICC survey. Adv Neonatal Care. 2017;17(3):209-21. [2] Gupta R , Drendel AL , Hoffmann RG , Quijano CV , Uhing MR . Migration of central venous catheters in neonates. A radiographic assessment

One way the investigators could improve the safety of neonatal PICC lines is monitor them more closely. Current standard of care is to monitor PICC line tips on chest x-ray. Unfortunately, there is strong evidence that chest x-ray does not accurately identify the PICC line tip location. Another way would be to use POC ultrasound A 2.0 kg early-term infant with congenital heart disease required central venous catheter placement for persistent hypoglycaemia. A 1-French peripherally inserted central catheter (PICC) was placed in the basilic vein of the left forearm and advanced to 13 cm, commensurate with expected appropriate depth given preprocedural measurements. Point-of-care ultrasound (POCUS) was used to confirm. peripherally inserted central catheter (PICC) provided: 1. The Registered Nurse is trained and competent in the procedure. The training should have all components of a formal certification course to include but not be limited to: indication for use, insertion technique, care, maintenance

Description. The 1.9/2.0 Fr, 30ga Modified Seldinger Introductor (MST) Kit provides safe and easy vascular access of premature, neonatal patients as small as 22 weeks/480gm. The MST is designed to be used with our line of neonatal PICC catheters for neonates and has a .010-inch (diameter) nitinol guidewire for easy insertion and viable access. The 30ga dilator tearaway protects fragile skin. Institutional and national PICC guidelines include basic MC information, but VAD decision making may be based on clinician preference rather than clinical evidence due to a lack of evidence based research in the form of high quality studies (National Association of Neonatal Nurses PICC Guidelines, 2007). Whe GuardianPICC™ - PICC-2. The GuardianPICC™ is a silicone catheter that has been designed specifically for the neonatal patient. It is a fully radiopaque catheter with indelible markings every centimeter and a short extension tail. · Silicone · 2 French catheter · 28 cm in length with 25 cm of ink marking The Clik-FIX™ Neonatal PICC catheter securement device (NPS-1006) is designed with patient care in mind. It features a soft foam securement base with no hard plastic parts to cause pressure points, bruising, or trauma to the baby's skin. The built-in chevron securement straps lay over the catheter wing to stabilize the catheter and.