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I'm a fairly new grad and a really new ER nurse (6months in ED) I have been terrified of starting lines on anyone under the age of 10.

I had to start a line on a 2yo that had been kicked in the face by a horse and was in danger of loosing his airway...No problem with that one! I think it was God's own hand guiding me. That (by the way) was my first ever IV on anyone under the age of 12.

But, yesterday was a very bad day for pedi pt's in my ED. I had two dehydrated pt's that needed IV's with labs drawn. They were poked 6 times I poked once each and the house sup and ped's nurse each tried a few different times until they got a line.

I do NOT want to do this again. I would love any tips or tricks for pediatric IV's. The first IV I tried was an AC on a 1yo. I got flash and tried to thread, when I tried to draw labs it just stopped. I flushed and it wasn't in the vien. do you think I went through the vien? (I was using a 22--too big??)

And mom and dad in both cases were completely freaking out.

ANY thoughts or advice you have re IV's and care of dehydrated little ones would be greatly appreciated.

[frpeho]

I work in out patient pedi for 25 years. We hydrate pts there. Yes, it is difficult for us seasoned nurses to begin IV's on the little ones, especially if they are dehydrated. You are not alone. Sometimes we take 3-4 sticks. And we're sweating too! Some tips: You can discuss with the parents if they would like to leave the room while you start the IV. If they stay in the room, than have them help hold the child, explain why this is important. Have help to hold the child. Sometimes it takes 3-4 of us! A 22ga angio is good. Be sure to secure the IV, using a board, cover with gauze, or follow your hospital policy. Good Luck! DMG

[TsunamiKim]

That was one of my phobias when I worked in the ER. I did find out about one useful trick for Peds IVs. A Nurse I worked with in the OR said that a flash light under the hand of an infant helped iluminate unseen veins. I have never had an opportunity to try this, but it worked for her.
I have a good tactic for calming kids who are about to get sutured though:
I place a thread like a tie in their hand and have them hold on to it loosly. I then pull it gently through their hand and ask: "can you feel that?" They say yes and I ask: "does it hurt?" they answer: No. I tell them they will feel the suture, but just like the thread it should not hurt. I then take a pencil or a pen and touch their hand, again I ask if they can feel the blunt tip and does it hurt? I say after the anesthetic you will feel the tip of the suture needle, but it shouldn't hurt. This is important as I have found that it is often just the anticipation of pain that traumatizes these children. The only hard part then is injecting anesthetic, but after that it is easier and they settle down allowing a reasonable chance for good closure. I used to have to restrain the child and I felt like the chief torturer. Good luck Kim.

[PedsER-RN]

When I started I was also a nervous wreck about IV's. The only way you can get over it is to do as many as possible. Here's what's helped me:

1. Start with a FLAT angle (unless it's AC or deep FA). If you're too shallow then you can always deepen the angle but if you start deep you're more likely to go through it.

2. Gently glide the needle in rather that pushing-kids have softer skin than adults.

3. As soon as you have your blood drawn, flush. They can clot quick! Use a hep lock if it's part of your hosp. policy and isn't contraindicated.

4. Illuminate hands (generally for <2-3 mo.) with a speculum-turn off all the lights so it'll work!

5. Warm packs may help pop the veins up.

6. Make sure you have a good holder-some kids can really twist their elbows.

7. Once you get a flash, start threading. You only need the bevel in the vein, not the entire needle.

Good luck

[HanaRN]

Thanks for all the wonderful tips!
I also found this sight that has tips on IV's, NGtubes, catheters and Peds IV's, I found it very helpful!

http://mynursingtips.com

[patrice meursault]

Try not to psych yourself out, alot of it is mental. Have you ever noticed if you miss your first IV attempt of the day, the rest of the day will be filled w/ multiple sticks. Transversely the same applies. Or if someone asks you to try to get a person "with bad veins" and you get it!
A good holder is very important, set all your equipment up out of the room and have everything ready to go. I also put the tourniqet on rather tight, it distracts them from the pain a bit and helps me palpate the vein ( works on adults too).

[Annony RN]

To add to some of your other tips-

Yes, try transiluminating and without for the best ideas.

I tell parents we are going to do a lot of looking- and we do. I look everywhere before I decide.

Don't forget to look at feet in your babies. Officially for pre-walkers but sometimes I'll put them in toddlers as a quick fix. By the time they are well enough to walk and play (might be 15 minutes, might be days) we can decide what to do next.

Along the same lines, i veins seem prone to blowing or it is a routine n/v/d dehydration, etc, I put in a 24. It might be easier to replace a 24 with a 22 or even more after the first couple boluses. The amounts of saline needed to resuscitate a kid will get in there just fine with that 24. If they look crumpy you might just want it anyway as a secondary to the larger cath you hope to get in.

Another tips for veins that blow is to try without a tourniquet. Sometimes that works in the little guys.

Always have a flush ready. Sometimes it's easier to float them in.

Not best practice and I shouldn't admit it but I will tell a secret. Sometimes we advance as much as we can then slap that tegaderm on even if part of the cath is still not in the skin. Sometimes with the twists and turns make it impossible to advance to the hub. Sometimes we do and find we need to pull back a bit to get it running again.

You'll get a feelfor when you want to get your labs off the IV and when you'd rather get it running and get labs from a separate stick.

[Jolie]

Originally Posted by Annony RN

Another tips for veins that blow is to try without a tourniquet. Sometimes that works in the little guys.

Always have a flush ready. Sometimes it's easier to float them in.


You'll get a feelfor when you want to get your labs off the IV and when you'd rather get it running and get labs from a separate stick.

Some very good advice here. In my experience, tourniquets are rarely helpful, and often harmful when starting pediatric IVs. Instead, I will have a helper hold the extremity with mild pressure to act like a tourniquet. It seems that a "real" tourniquet is too harsh, damaging fragile little veins, causing them to blow.

Also, if you are at all uncertain of your IV skills, especially in a dehydrated child, get the IV in first. Although you want to spare the child a second stick, it is not worth losing an IV to draw labs which could be gotten another way.

Hang in there!