[wandernsoul]

Never had to question this before in all my ER years. Had a 16 month old with persistant vomiting, chunky but nearly bald little girl. As we (another traveler and myself) were looking for IV sites the mom commented on the child's scalp veins, which were quite prominent since she was such a little cueball (a very cute cueball!) After several peripheral attempts that were unsuccessful the other traveler was ready to jump on the scalp vein, or a foot vein. I mentioned that we might need the docs approval (I don't know this hospital's policy). She seemed quite miffed by this but spoke with the doc who was less than anxious to go either route (bear in mind this child had been sick for about 2 hours and not looking "scary sick"). I gave her a Tigan supp. , started giving her sips of Pedialyte, and reported off to the other traveler as my shift was over. I'll find out today what happened. But my question is:

Do any of you use scalp veins in kids? If so, is it policy or requiring an MD order?

Thanks much.
Beck

[SmilingBluEyes]

We ROUTINELY use scalp veins on newborns in our nursery. I would think IF needed, they could be in ER on 16 month olds, as well. WHY put a child thru several failed sticks, if one vein is that prominent? Remember, too even though not "scary sick"that baby could have been dehydrated and therefore, peripheral veins harder to cannulate.

That said, protecting ANY IV site on a child that age is a challenge,and I would think a scalp vein, especially so.

[athomas91]

most of the hospitals i have worked in "as policy" don't allow the ER nurses to use the scalp veins - probably just due to the fact we don't do it much - we usually call the nursery or the np on up in the nursery to do those...

[Dave ARNP]

I've never heard ANYONE question using scalp veins in a little one. Those little veins are hard enough to find, and when they are in a position that they NEED an IV, it's usually harder.
HOWEVER, rarely does anyone in our hospital do one unless they are a ped's nurse. Most of our nurses think they look so pitiful with one, and "Hate to do that to such a tiny little person". So, rather than try it and not get it perfect the 1st time, they get a ped's nurse in to do it, as they handle them more often.


Interesting point though, had never thought of it.
And BTW, no one has to ask permission to do one.

Dave

[Mimi2RN]

I would rather do one good stick in a scalp vein, than subject a baby to several other sticks elsewhere. Some nurses don't like to do them, so they'll tell me it's mine.............. We don't have to ask permission, either.

[BarbPick]

Newborns are the only ones I use a scalp vein on. I use a #24 insyte cath in the scalp. I put PICC lines in a newborn's wrist. I use the foot up to Two years of age. I use the two notch veins between the wrist bones on all children as a blind stick, just above a bent down wrist on "chubby " little hands.

It is a good idea to practice these areas of vascular access on your friend or roommates, just look but don't stick. The more you practice finding them, the easier it will be at crunch time.
Barbara, my first certification is CRNI .

[SpnshEyes1975]

When I worked at a Childrens Hospital, it was quite common to use scalp veins on the younger babies, but since I came to the ER, I've only seen it once. I guess it just depends on your specialty and talent! :ROTFL:
Rachael

[teeituptom]

As a long time ER worker, we use scalp veins if needed. it still is preferable then some MD sticking in an intraosseous line

[traumaRUs]

I work in the ER and we routinely stick heads, feet, whatever else we need to in order to get IV access.

[veetach]

I have worked in various ED's over the last 8 years, and have no problem sticking a foot. However I have only seen docs use scalp veins. If we cant get the IV in the ER, we usually leave the scalp veins for the peds nurses to try. We dont have to have permission either.