Hello all, I interviewed for a hospital position yesterday. I am a new grad and didn't get the interview for the posting I wanted and they offered to have me interview for a peds floor position. After touring me around the floor and showed me the room where they start the IV's I just felt like I went pale. I didn't have trouble with adults during clinical but never did we start any IV's on babies or children. I am completely in the weeds on this. I observed staff nurses starting or attempting to start them on little ones during clinical and it was a real challenge and usually took several to nurses to be successful. What are the best veins and where is the best sites for little ones. I am fearful of it all together and how will I be successful at something I told myself in school "that would be off limits for me" and now I get the official job offer for an acute care peds floor!
Starting an IV on a kid can be more challenging than adults (though some adults are big babies). It also depends on the age of the kid. Your teenagers (13 and above) will basically be an adult in terms of IV's, and they usually have great veins, so don't worry too much about them
The school age children (7-12) are usually pretty good. They too have good veins and you can usually get away with a larger bore IV (such as a 20) if they need it. These kids are pretty industrious so you can employ their help. Remember that they will get scared more easily than the teenager, so remind them that the initial pinch is all that will hurt. Show them how soft the collapsed angio is and tell them that the needle will come out. Make sure they know that all of their blood won't fall out. The key is to tell them to stay very still so you get the IV on one shot. If the kid becomes hysterical, it will make things much harder for you so keep them calm. Generally, this age group isn't too bad.
For smaller children (4-7) things become a little more difficult. You can try to explain things to them and some are good and others aren't. You should have mom help you by getting ready to hold the kid down, even if they promise not to move. Make sure you have all of your tape and supplies at the bedside because he will most likely become hysterical once you stick him. You might want to put some benzoin on in case the kid becomes sweaty, that way your tape sticks and you don't lose the IV. These kids usually have decent veins and you can get a 22 into the dorsal hand, forearm or AC. Again, if you can convince the kid to act like a "statue" and not move, it will make things much easier for you.
The "tolders" (18mo-3 years) are probably the most difficult. These kids can't be reasoned with and don't understand what is going on, but they are usually big and strong enough to fight you tooth and nail. Never try to line a kid in this age group by yourself. Employ the mother and get a tech or another nurse to help you. Get all of your supplies at the bedside and have an armboard and a gauze cling ready to go. Wrap the baby's legs and one arm in a folded sheet or blanket, tell her you are going to play the "mummy" or "hot dog" game. The kids usually trust you at this point. Tie a band high on the arm, but start looking at the dorsal hand. Most kids in this age group are plump so finding a vein can be tough. Be sure to feel as well as look. Try rubbing a chloroprep or alcohol hard against the skin, this sometimes makes some veins pop up. The hand is the best bet, only use the AC if necessary. The IV's easily fall out of an AC in a kid and the kid can almost always twist that part of their arm, no matter how tight you hold him. This makes it very difficult to get the IV in. Stick with the hand. You'll only have one good shot to get the IV in. If you miss the first time, the kid will become hysterical and hate you. This makes it much more difficult to get the IV in. You should always use a 24 and a syringe. Once you get the line, secure it right away and place an arm board on the pt. Cover the IV tubing with the cling, but leave a part open so you can see the tip of the angio to assess the site.
Babies (>18 mo) are hard because their veins are tiny. However, you can usually find a good vein on the dorsal hand. If there is no vein that you can see or feel, try to use a "weelight". If you don't have one, you can use the otoscope and place it behind the hand to see if you can find a vein. If you don't see one, try the foot. Personally, I find more veins in the babies' feet than in their hands or arms. Avoid the AC unless 100 percent necessary. Always use the 24 and secure it like you would a todler's IV. If all else fails, tell the doctor to do it.
Last edit by MikeyBSN on Sep 17, '09