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RELFECTING, AGAIN, ON SETTING UP A NURSE-LED PAEDIATRIC PICC SERVICE: LOOKING BACK OVER THE LAST 5 YEARS.
The vascular access (VA) team was established at King’s College Hospital (KCH) in 2009, primarily concentrating on improving infection control practices, reducing the incidence of IV catheter associated bloodstream infections and the standardisation of vascular access devices. While the insertion of PICC lines for adult patients was introduced 12 months later. Since the inception of the team, one of the vascular access practitioners was from a paediatric background and therefore was willing to take the challenge of establishing a dedicated paediatric service. This has taken 14 years of various iterations and service design before landing on the current configuration.
Training
The nurse-led PICC insertion service, initially established in adult patients, involved the VA practitioners training in interventional radiology with radiologists using fluoroscopy for successful PICC placement. This evolved to the team gaining expertise in PICC placement using ECG guidance using the BD Sherlock device. After this service had been running for several years, the attention came back to paediatrics, with one dedicated VA practitioner shadowing Paediatric Intensive Care Unit (PICU) consultants to gain proficiency in PICC insertion in paediatric patients.
Trial and interim periods
After a trial and interim period where children >10yrs of age were accepted for PICC insertion in the operating theatre, it became obvious that the current provision was not meeting the demand for PICC lines in paediatric patients. The number of PICC lines continues to increase every year, from 6 in 2014 to 147 at the end of 2025 (and over 50 already for the first 3 months of 2026).
Building the dream team
As a result of this increasing demand, the need for a larger team became obvious. Thanks to the patience and dedication of the original VA practitioner, now Lead VA Practitioner for KCH, an additional VA practitioner joined the paediatric service in 2021. In 2023, a formal training programme began for Advanced Nurse Practitioners (ANP) within paediatrics to increase the service again. Since then, 2 ANPs have joined the team on a permanent basis, providing a 2 day a week PICC insertion service, with 2 more ANPs having completed their training and 3 more who are progressing in their training. The ultimate goal being to be able to provide a holistic, flexible and comprehensive PICC insertion service for paediatric patients and KCH and other referring hospitals 7 days a week.