IVs on baby-Am I too sensitive? - Page 3Register Today!
- Apr 25, '12 by Good Morning, GilYou're not over sensitive. This is exactly why I don't work in peds. I probably could handle the little kids because at least you can explain that this is to make you feel better, but babies just cry and cry, couldn't do it. That's why there's many different nursing areas. I'm glad that you made the extra effort to comfort the baby, and seasoned nurse or not, that should be done if multiple sticks were required (if not an emergency situation).
Best of luck to you!
- Apr 25, '12 by MattNurse24 lbs sounds huge for a 6 month old!
- Apr 25, '12 by jadelpnMaking sure the baby can't wiggle out of the way is, in my opinion, the key to being able to get a good IV on an infant. Parents can not usually hold their own child down and will often say "forget the IV" should it be a tough stick. That could be more dangerous than the IV insertion. I have also used blankets before, and bound the baby in them with an arm out. A third person to hold the arm steady is also an idea. It sucks, it is tough, but better red than dead. And if the baby was dehydrated (vomiting?) the LAST thing you want to add to this is more PO fluid to have the child apsirate it. A binky is a good idea, a little sugar water dipped is a good idea--but a full out have a bottle is not. Here's the good news--the baby was lively, and thrashing and crying....good signs, as the sickest infants I worry the most about are the ones who passively lay there and don't cry or turn red. Tourniquets are necessary, as you often can't "see" a vein on a 6 month old, unless they are really, really small babies, and even then, not always. (and at 24 pounds at 6 months, not so much). You need to feel for them, and the tourniquet helps to do that. The best thing you can do is to really get a feel for all sorts of veins. They should feel like an elastic band that has stretched and bouncy. Once you feel it, and practice feeling for it, the better you get to the point of knowing it when you feel it.
- Apr 25, '12 by classicdameOur pedi dept uses ultrasound guided IV insertion. Prevents multiple sticks and is a patient satisfier (keyword to use to justify cost). Also, I have found the vein in the forehead to be more accessible in 6 mo olds who are chunky but dehydrated. BTW, crying only dehydrates further. Talk to mgr about this and have some suggestions to offer.
- Apr 25, '12 by Esme12Quote from schwartz 018you should not have messed with the tourniquet and may have lengthened the time it took to get that iv. if you aren't the one starting the iv stay out of their business. a tourniquet is necessary ona 6 month old infant. they have fat little arms and tiny little veins....add dehydration to the mix and they are flat tiny little veins. i am excellent at iv's and i am 99% for one stick. i hate dehydrated chunky babies with dehydrated veins.thank you for the feedback. to answer your questions-in nursing school i was taught that a tourniquet really isn't necessary unless you absolutely need it and it is painful. i personally think a tourniquet is worse than the iv on me so i took off the tourniquet after they got in, perhaps i shouldn't have. ( what!!!)pedialyte is stored at the opposite end of the unit and when i was sent to get supplies i had to hurry so the room we were in had water and that's what i used to moisten the baby's mouth. maybe 1 ml was total all that she got. they did not use a light or warm packs but that is a very good idea that i wish i would have thought about.
one of the most horrible codes i have ever participated in was a baby that was dehydrated. this baby was so dehydrated that we couldn't find the proper anatomy in a cut down during the code. when i saw that baby in triage my heart stopped and i peed my pants.....i knew we were in trouble.
yes, that baby cried and screamed, at first, with every stick. she cried with the tourniquet. she cried when we had to hold her still yet she never shed a tear. then she stopped crying and laid there with hollowed eyes limply. then she coded.....and died right in front of our eyes because she was dehydrated and we couldn't get an iv in long enough to replace fluid fast enough. lights and warm packs would not have helped in this baby.
she was of asian decent and had been ill. her very traditional family had been coining and cupping her at home....they sought western medicine as a last resort. they were desperate....and too late. i will never forget as well all watched her slip through our fingers and there was nothing we could do......we were doing everything we could...iv, io, sq, central and finally a cut down. we failed. she died.
for me as a an emergency nurse as screaming baby is comforting for it's when they stop crying i become afraid......it's an ominous sign that the child is very critical and going to code. trust me when i say this you are going to remember this experience a whole lot longer than this baby will.
if i was the nurse starting the iv and you interfere i would remember it for a long time as well....besides when i was done i will be pulling you aside and kindly educating you on the proper way to best assist me and keep the patient safe.
once i have that life line....i will rock that baby until we are both comforted. but a baby "screaming" and has no tears, dry lips and mucous membranes is an emergent situation......you find that iv if it kills you so the baby doesn't die. it is a big deal!!!!! if this baby could take fluids well........ it is obvious that she certainly wasn't getting enough or she couldn't get enough....there were no tears.
you say it took about 45 mins to an hour.....not bad with a difficult stick. if you are going to work peds i suggest that you take pals and enpc while geared towards emergency nurses it is an excellent course in the care of children/babies and how to recognize the warning signs before a child is critical. children are not little adults...they are specialized individuals that require specialized care.
emergency nursing pediatric course (enpc)
enpc .......a course designed to provide core-level pediatric knowledge and psychomotor skills needed to care for pediatric patients. the course presents a systematic assessment model, integrates the associated anatomy, physiology and pathophysiology, and identifies appropriate interventions. triage categorization and prevention strategies are included in the course content.
if this baby could rehydrate she would have been hydrated and had tears on the first stick....there was obviously a problem and the iv needed to be done. torturing a baby by allowing them to become completely calm and the starting again just isn't in the best interest of the baby. give the baby a break when you can while waiting for supplies but get the job done....there is time for hugs later.
i usually don't like the papoose. i prefer to have the baby restrained by trusted co-workers that i know will not let foot wrapping them in a tight sheet and swaddle them. i try to keep the parents at the bedside if they can take it (and the only sitting in a chair not holding the baby)....if not i will go to a procedure room or ask them to go get some coffee. i like the use of the paci dipped in some sugar water like d10......it comforts them and there is some documentation that when sucking and the release of endorphins and the decrease of pain.
please...in the future don't take the tourniquet off unless asked say something....."do you need me to release the tourniquet?" and above all........educate yourself some on the ways of peds. crying babies are good...quiet babies are scary.Last edit by Esme12 on Apr 25, '12
- Apr 25, '12 by CrazierThanYouQuote from VespertinasI agree. In my third semester of nursing school, I was assigned to the special care nursery and witnessed IV starts on sick babies. One poor little baby girl was stuck repeatedly until they FINALLY got the charge nurse who brought a light to illuminate her veins.This is a perfect example that many student nurses who wish to work in peds should first hear about...just for starters.
I don't think caring for sick babies is my bag after all. I can TOTALLY see how the OP was traumatized. I probably would have been also.
In another situation, as a CNA, I was asked to help restrain an elderly woman who was having an NG tube inserted. That is a pretty benign procedure but for me, it was horrible. The poor woman was screaming and crying and gagging and struggling.
- Apr 25, '12 by Cmatt13I worked in a peds ER as a tech for a long time before I became a nurse, now I work in an all purpose ER and I get stuck with the dehydrated babies all the time! I agree with all of those who say warm packs are the way to go, and if you can get it approved on your unit, EMLA cream is very useful but must be applied prior to the IV start.
On kids who were super-duper dehydrated, I've seen them put in an I/O (equally as horrible to watch, but somehow ends up being quicker).
The peds docs (and nurses) always told me no baby ever cried himself or herself to death--which is hard to remember when the kid is screaming in your ear during the 5th attempt and the parents are breathing down your neck.
If it's any consolation, I've seen kids scream themselves hoarse/asleep just from being restrained during an IV start--no needles even involved.
- Apr 25, '12 by HorseshoeQuote from Esme12My first thought when I read the OP and (s)he relates releasing the tourniquet because in her past she didn't like it, was "What audacity." It just seemed extremely presumptuous. I appreciate compassion for patients in pain, but seriously, ASK first. I'm glad she has been open to the possibility that she was wrong to do that.You should not have messed with the tourniquet and may have lengthened the time it took to get that IV. If you aren't the one starting the IV stay out of their business. A tourniquet IS NECESSARY ona 6 month old infant. They have fat little arms and tiny little veins....add dehydration to the mix and they are flat tiny little veins. I am excellent at IV's and I am 99% for one stick. I hate dehydrated chunky babies with dehydrated veins.
Please...in the future don't take the tourniquet off unless asked Say something....."do you need me to release the tourniquet?" and above all........educate yourself some on the ways of peds. Crying babies are good...quiet babies are scary.
- Apr 29, '12 by turnforthenurseRNIt is awful to watch them suffer, but think: they NEEDED the IV and in the long run, you are helping that baby. I wouldn't have used those restraints, though. Where I work, we get coworkers to help hold the child down.
- Apr 29, '12 by canned_breadFirst of all, you sound very kind hearted. I work in a children's hospital, and sometimes getting a line, especially on a very dehydrated baby who is chubby but has tiny veins can be very hard. We have a rule that is 2 sticks and then you have to pass the baby on to either another more experienced person to attempt, or straight to an anaesthetist who will surely get one in. There is plenty of studies that show different methods of pain reduction; we use distraction (clowns etc), sitting in mums lap with another nurse holding the child, shiny coloured fans or a sucrose gel on the pacifier and we NEVER EVER use restraints (it sounded above like that is what you do?!). If there is time, and we know its going to be a difficult cannulation then we use EMLA cream, but most times there just isn't any time.
Sometimes it's cruel to be kind... It's a tough thing and I wonder about the long term effects on a chronic child who gets stuck weekly or so.