IV Sticks in a pediatric pt - page 3
I'm not a pediatric nurse, but I work in a rural hospital where all age groups and illnesses are thrown together on the same floor. In 15 years I've never started an IV on a pediatric pt. ER does it,... Read More
Aug 2, '10One more thing....you have to have a good holder to assist you!!! That's half the battle!!!!
And if it's a child that has had multiple IVs in the past, always ask the parents where the best/worst place is! Parents know best!
Aug 2, '10Quote from imintroubleAs a parent I'd be outraged if my hospitalized child was unable to have their IV for several hours due to no one being willing to try or a lack of adequately trained staff.As a parent, I would be outraged if an inexperienced med/surg nurse was poking needles in my child.
If you're never willing to try it then you'll never learn to do it.
Aug 2, '10Quote from pitterpattershoppeAs an experienced Pediatric RN who has started IV's in maaaaaaaaaannnnnnnnnnny children I do not appreciate being interrogated by parents. I'm not starting an IV on your child for my entertainment. I do care if it hurts. I want your child to get better. We are human, we don't always get the IV on the first try. Movement, vein size, hydration status and how many previous attempts all make a difference. Your interrogation starts everyone out nervous that they might not get it. How about instead of interrogating you understand that we are there to help, not hurt your loved ones.Let me just say that as a mother of a child who has a rare disease...THANK YOU for not trying. I interrogate everyone before he/she sticks my child. We had a bad experience once and that was enough.
My DH was just in the hospital with a bunch of new nursing graduates. The rule is try twice and then get someone else. I was just about ready to scream at the insane number of mis-sticks.
Sep 7, '10Truth is YOU MUST TRY. If you thinks parents will be upset you better know that MOST parents are already stressed out! If you are serious about succesful IV start then you must give it a try. Sorry no other way around! Practice makes perfect. Cannot learn from watching. With babies often you will not see a vein but they are there, use you touch and find them and ofcourse use an extra set of hands to keep the child from kicking. You can always suggest to the parents that "This is the best time for you to take a coffe break or just go for a walk" that way there is less pressure. Good luck
Sep 16, '10This bugs me for you and for all of your potential pediatric patients. While starting IVs on little ones is a great skill to have, sometimes you just don't feel comfortable doing it. There's nothing at all wrong with admitting your lack of skill in that regard. What I find completely unsatisfactory is your supervisor's attitude toward the whole thing. He/She delayed care for this child needlessly "just because"? Not the most intelligent decision, nor was it the best for the patient. Wow.
I've started thousands of IVs on babies. While the saying is true that the more you do the better you get, as a dad I say "find the most experienced person, please". You could have tried, you never know. I always at least LOOK with the tourniquet on to see if I can see/feel a vein I feel comfortable sticking. If you don't see or feel something, at least you can say you gave it a look but didn't feel comfortable. No harm, no foul.
As for the veinilite...I don't like them. While they are wonderful for visualizing veins you couldn't normally see, they are awkward and bulky and they don't give you a true sense of the depth of the vein. The IV team where I work relies solely on them, having completely lost their ability without relying on that new technowizardry. It should be used to supplement existing skills, not replace them.
Sep 24, '10Unfortunately this is a skill not often taught well enough in school. Now that you know what your weaknesses are you should take steps to educate yourself and do not depend on your employer to do that for you. I would first recommend that you read a chapter on pediatric IV therapy in an IV book. The book from INS is good as well as Plumber's Principles and Practices of IV therapy. The statue of limitations for pediatric patients lawsuits is much longer than in adult cases. Yes...IV therapy related lawsuits in all ages is fairly high...so I commend you for your thoughtful consideration of the matter...just because you did not try does not mean you did not seek out appropriate care for the child. I get calls all day long and no one has tried b/c they can not see or feel anything and do not want to just blindly stick. I have been starting pediatric IVs since 1989 and yes there are a lot of little tricks that I use. I would rather be called right away then get called after 6 sticks..by then the tops of the hands are gone...both ACs are toast and a foot or 2....then its really challenging and I often have to go in the scalp unless they have left me a saphenous..or I can find a piece above a vein that has been tried.
1. Have someone show you how to work with the smaller catheters and all the technical aspects of starting an IV. Find the best teacher..if that is an IV therapist that is great......first observe.,,then have them teach and then take every opportunity you can
2 Take the time to set up the child properly..raise the bed or gurney to your level...prop any arm or limb you need too....wrap the baby and leave out the limb you are working on.....GET someone that knows how to hold. I personally like to have control of the limb I need or scalp b/c the other persons hand usually gets in my way and messes up my ability to change my angle if needed
3. Take your time to assess and look carefully....the veins of children and especially newborns and infants will not look large..they often look like they will not accommodate even a 24 gauge..they WILL...you may not feel
the characteristic bounce on a vein in the hand or foot unless it is in the ACF or if is is the saphenous..that is OK
4 Some like to stabilize the limb before the venipuncture ..I DO NOT...that just get in my way however,get everything you need or may need out and ready (at an arms length) and flush secure it immediately after you have gained access and drawn the blood if needed
OK here are my tips
1 Approach the situation with confidence fake it if you have to
2 Minimize your audience if need be . If the parent (s) are not able to cope ask them to step out..assure them you will look very carefully and take your time. Many parents are an asset..it just depends...but always know what you are dealing with so you can help all involved. Assess the situation before you bring out any needles. I remember this one very large dad breathing down my neck in a threatening manner while I was trying to start an IV..he became unbearable . I pulled the catheter out..called the supervisor and told them I would do the start without that man in the room. They arranged that for me and I had that IV in within 5 minutes . Of course this is not always possible in an emergency
3 Assess carefully using a smaller width tourniquet...cut one to fit the size of the child...do not make it too tight as their skin and vein are more fragile . Apply warm heat on potential sites or look with the transilluminator. I have seen these nifty devices but I learned without them and do not need them...Select the vein you will try and have a second back-up one in mind
4 Select the appropriate gauge..I usually use a 24 gauge and on occasion use a 22 in the ACF or scalp...the scalp is very thick and it is often very difficult to get through it with the 24 gauge.
5 Anticipate that you will have a slow flashback as is often the case with children and especially infants . You probably will not feel that characteristic "pop" into the vein...so go slow and if you feel that slight change in sensation between tunneling under the skin and entering the vein STOP pushing the catheter and wait for the flashback. this is a common mistake when starting on IV on an infant...you were in the vein and did not wait for the flashback so kept advancing and went right through it. This is even more of a problem when the infant/child is dehydrated as is often the case.
6. In most case you need a very low angle for the venipuncture usually flush with the skin..the veins on the hands and feet are very shallow. You may need a slight angle (no more than 10 degrees ) if going in the ACF. Do not overlook the saphenous vein or the scalp vein. If you are using the scalp access the vein in the direction of the venous flow (towards the face).....make sure you do not select an artery..check for a pulse and check the color of the blood and see if the blood return is pulsatile ..there is a large artery that runs behind the ear and a supraauricular vein that is fairly close to it
7. So now you have the child secure...you have your assistant that is holding the child..you have all of your supplies out and easy to reach and open ..you have your vein selected and the heat pack is off..prep the selected vein and allow the prep to dry vein. Insert ht catheter flush or almost flush with the skin...stay on top of the vein so you can try to access it from the top of the vein..catching a mall vein from the side is difficult....pay attention to the feel of it and as you get closer to the vein you will feel a slight resistance ...keep going and you will pop into it soon...usually this does not feel very good and the child will move ....be prepared. After you get your flashback you can either slide your catheter over the needle or advance it 1/8th of an inch pull the needle back and then advance the catheter. I decide this while I am doing it b/c it depends on how I have hit the vein....if the child has moved and if I am concerned that if I advance it I will lose it,,then I just slide the catheter over the needle. Some will try to advance a catheter while flushing..this can be a bit challenging but doable
8 Immediately stabilize minimally draw your blood..flush and then finish your stabilization. Always stabilize the limb in a functional position with normal joint configuration maintained to avoid injury...pad the foot and maintain the natural bend at the ankle . check circulation after stabilization. Taping is an art in and of itself and often takes me longer than getting the IV in..but it is so important to do it well and properly.
9 Lastly ,always know what you are going to administer through this site. Extravasation and infiltration injuries are much more serious and difficult to treat in this population. NEVER leave an IV in that might be in the vein..take it out. Assess frequently for infiltrate/extravasation.....actually feel the site..it should be soft..compare to the opposite limb...know the date that it was placed.........teach the parents what to watch..they can be the best allies as they usually report problems early...... listen to them they know their children
Dec 7, '10Iluvivt:
Thank you for your wonderful tips! Fantastic, and really helped me to understand better the process.
Dec 7, '10Please, please, please beg and plead with your admin to get your floor a vein light. Ask for a private fundraiser, have a bake sale on your floor every week for a year. Do something to raise the funds.
I am a mom who has watched her baby, who is a a super hard stick with crooked veins, be stuck over and over. Now we won't let anyone try unless they use a vein light. We even brought our own for emergency visits to hospitals where our son is not known.
It appalls me that any hospital/lab would not use a vein light on a child. It is one thing for an adult to deal with two to however many attempts, but a child or baby should not have to. They do not have the life skills or even cognition to understand what is happening, much less why they are repeatedly getting hurt over and over. (Yes, this is a huge issue for me after fighting for my son for so many times.)
I have worked in healthcare since I graduated with my Masters, so I am a hospital employee too. It seems it is a patient care issue and nothing else. The vein light allows for access on the first try almost every single time. Why would that not be what should be done every time?
Really and truly, a vein light may not solve the world's problems but it really does help sick babies and kids! (And on a side note warm packs can help too while you are getting the hospital to buy you the vein light!)
Good luck and I hope they come through for you and your patients!
PS: Yes, you need to learn to draw on the peds patients, but as a mom I would have thanked you for NOT trying if you knew you weren't going to be able to get access. So on behalf of that mom, "Thank you."