True, a subtle leak can happen over time, and that is something to always be on the alert for. If the site hurts and there doesn't seem to be any reason for that, the things I look for are inappropriate taping (if the tape is pressing the hub of the IV catheter into the skin, for example, causing pain) or a slow leak.
I can't tell, Daytonite, whether you are expanding upon what I wrote or disagreeing with me, so I just wanted to clarify:
I know why there were two IV sites, I was saying that I didn't understand using the hand site for the vanco when there was a choice of two sites; I would have used the AC.
I know that tissue damage refers to even the slightest infiltration or phlebitis, I was simply pointing out that if this child had had an entire bag of vanco and all his IV fluids infiltrate into his arm all night, there would have been some severe damage. If he was discharged with no problems from the infiltration, the infiltration likely wasn't that terrible and had not been ongoing all night. I've seen kids whose IV fluids infiltrated badly, and it looks horrible and scary; neurovascular checks every 15 minutes, vascular ultrasounds, consults with vascular surgeon, etc. None of this was apparently needed, and the pt was discharged later that day. My point was perhaps it was not as bad as the nursing instructor and the student thought it was, and their dislike of this nurse could be coloring their perceptions. That's all.
In any case, like I said, I'll bet the student never skips IV site checks, be they on peds or elsewhere.
And just public service announcement to those out there in the nursing world-most pumps can be set on a lower pressure. Some older pumps just have two settings: General population and pediatric population. Newer pumps have a variety of settings; our Alaris pumps have pressure settings of 100 to 500, with the standard adult population setting at 375. I don't work peds anymore, so I don't know what the programmed default pediatric setting is. I just wanted to throw out there, though, that with your pts who have bad veins and who are at risk for infiltration (your older pts, those who take chronic steroids, high risk meds, etc), you can always change the pressure on the pump to the pediatric setting. The pump will then alarm sooner, with less pressure, in the event of an infiltration, reducing your pt's tissue damage. I find that many nurses are not aware of this, and *I* did not know it until I went to peds. Now all my at-risk pts get a lower setting. Flip side is their pumps alarm occluded more frequently when it's merely positional, but I'm okay with that.