IV Nursing among Pedia
- 0Dec 2, '08 by kxanuddinI am an ER nurse, been on this area for 5 months already. Everyday I get to perform IV insertions to my patients. I encounter little problem with adult patients. But pediatric admissions are like nightmares for me. I am seldom able to successfully initiate a patent and good-flowing IV line with them. Many times have I called for the assistance of my seniors and this is quite frustrating for me. It is already hard to keep their limbs steady and it is doubly hard for me to find them a good vein. Yes, it requires a lot of practice and experience, but i don't enjoy the idea of having to "practice" on little kids. Hope you could share some tips and strategies with me regarding this. Thanks a lot.
- 2Dec 14, '08 by iluvivtOK I will try again to answer your questions. First let me tell you that this is a skill that does take time and good training.....so if you are able to get an IV in you are doing well!!! Let me first give you some general advice and then we will get into some specifics.
1. You will be suprised how much you can learn from just observation and assisting another nurse....so volunteer to do this every chance you get.
2. Educate yourself about pediatric IV therapy. Purcahse an IV therapy book such as Principles and Practices of Infusion Therapy by Ada Plumber and read the pediatric section. The complications that occur are far more severe in this population and the statute of limitations is very long in pediatric cases.
here are some specific tips for Pediatric IV Therapy
1. Assess carefully b/f performing any venipuncture (unless emergent). This includes looking at all possible limbs and sites. Do not forget to assess the scalp if the patient meets the criteria for its use.
2. OK to place a heal warmer or heat pack or warm blanket at selected site. This will help you with a blood draw from the catheter as well.
3. Do not apply the torniquet too tightly and consider not using one at all if patient is very fragile. If you still need one cut it down to size by trimming it down the middle. Also can have someone use a hand tourniquet be gently applying wrapped fingers above the selected site.
4 Get all the supplies ready and position them so you can grab them easily
5 Control the enviroment. Of course, I let someone stay with the child if they so desire but I will not allow more than 2 family members in the room and if they are not coping well I encourage them to leave.
6 Positioning the patient and getting an assistant is essential to your success. If I do not get a good holder it makes my job at least 50%more difficult. Wrap small children in a snug blanket and then isolate the limb you are working on. I like to prop the upper part of the limb on a towel with the lower part of the limb downward (so vein stays full).
7. Now you are ready for the venipunture:
a. Hold the limb yourdelf with your non-dominant hand. If using the hand fold the fingers down and keep the hand flat. Same with the foot..hold the toes down. You do not need a sharp angle on most of these sites. Go in flush with the skin or no more than a 10-15 degree angle. then on these very small veins try to get back on top of them and enter from the top. Once you get a flashback...drop your angle (if not already flush) advance about 1/8 inch more ..pul back the needle and advance the catheter.I find that on pediatric veins the nurses are often going too deep and nicking them from underneath the vein or catching them from the side and advancing them out doing a through and through puncture.
b. Tape all pediatric sites well with tape that gives and limbs must be in a functional position. OK to use armboards...just check distal circulation...use only tape that gives...do not wrap tape around the entire limb or use any roller type bandage on the sites (ie Kerlix). using a roller type bandage is against the standard of care...stockinette is OK
NO products (such as NS and Heparin) with preservative should be used on neonates. The preservative can cause a fatal gasping syndrome as well as other problems
use of CHG is contraindicated 3 mo or younger..... Last time I checked Iwill look into this
let me know if you are interested in some scalp vein information and tips. Tx for being patient...my schedule has been brutal the last 2 weeks