IVs on baby-Am I too sensitive? - page 4
by sschwartz018 6,990 Views | 34 Comments
I graduated 3 years ago. I am new to the peds floor. Yesterday we started an IV on a 6 month old baby who was slightly dehydrated and VERY chunky (24 pounds). I was comforting the baby while the IV team nurse and my trainer... Read More
- 2Apr 29, '12 by NicuGalI don't like the restraints either....I am sure that contributed to the frantic-ness of the baby! They hate to be restrained. We will get someone to hold and we will papoose them in a blanket with the appendage to be stuck hanging out. It has to be done though.
And a tourniquet is a must in kids, I have used them even on tiny preemies. Kids don't have the veins that pop up like adults do...they have lots of body fat and usually when they come into the hospital they are sick. Our peds and PICU don't use EMLA on most kids, you need an IV and usually you don't have time to put it on and wait. And I would have had your head if you pulled the tourniquet off while I was doing the stick..unless I ask you to do so, don't touch.
Kids with RSV...usually need an IV for hydration and your baby sounded dehydrated. Also, if they are breathing rapidly do not want to give them PO fluids...they can aspirate. Sometimes when you are in this situation, all you can do is grit your teeth and stick.
You have to have a strong heart and soul to work in peds...a lot of what we do is not nice and kids yell and scream and carry on (I know some adults do too lol), but it is our job. Sometimes you have to be the meanie, but luckily kids forgive you! And I'd rather have that baby screaming than one that lies there and does nothing when you stick them...those kids scare me!
- 6Apr 29, '12 by NotReady4PrimeTime Senior ModeratorMany of the responses to your post have been spot-on, sschwartz018. In PALS where the child is pre-arrest or in arrest, we're taught that we have no longer than 30 seconds to establish IV access then we move to IO insertion. IOs are much quicker to place because the landmarking is straight-forward and the space where the tip of the cannula is going is much larger. BUT, we're pushing a stainless steel needle the size of a skewer through bone - very painful. So in a case like you've described, where the child is struggling, crying and needing to be restrained, it would never be considered. Crying raises blood pressure and also plumps up veins so in some situations it's actually a good thing. As rn/writer stated, children compensate so well that they can fool us into thinking they're not as sick as they really are. When the crump arrives, it can be catastrophic.
When I was reading the comments about offering the baby a bottle, I nearly choked on my coffee. I can't think of a better way of making things worse than that. Babies with RSV are tachypneic, they cough (often until they puke) and their noses are packed with snot. (Obligate nose breathers, remember.) Tachypnea and bottlefeeding are a recipe for disaster - or at the very least, aspiration. It's difficult to coordinate breathing, sucking and swallowing for many babies at the best of times. Throw in all those other factors and they're going to fail. On our unit we don't even feed these kids via NG until they're well on the road to recovery. We place a small-bowel feeding tube for them so there's little risk of emesis and aspiration. So while sucrose on the pacifier might not provide the same endorphin release and analgesia in a 6 month old as it does in a 6 week old, the sucking and the sweetness can be just distracting enough for the baby to facilitate things.
I've never seen a child cry themselves to death. But I have held down hundreds of children for things like IV insertions, LPs, bone marrow aspirates, foley insertions and assorted other procedures. And most of the time I get a smile and a hug before the shift is over.
- 0Apr 29, '12 by ~PedsRN~I can watch them stick babies all day long. I'm immune to the screaming babies... because I'm their advocate, I'm doing what needs to be done to make them better. I do hate to see the moms and dads flip out though. That hurts my heart because I'm a mom. I've been there when they were trying to get a line on my R/O sepsis 19 day old... and it's heartbreaking. I'm a peds nurse (a new one! ) and I will NOT stick a baby. LOL... not yet. I love my IV team nurses. I spend my time holding babies down, and when I'm not holding babies down, I've got my arm around mom/dad. I often take them out of the room, or offer to take the baby to the treatment room for the procedure. It's just easier on everyone.
- 1Apr 30, '12 by umcRNQuote from ~PedsRN~I'll stick a baby ANY day over a 6 year old who can scream at me! (former NICU now peds cicu nurse). I am still super nervous and uncomfortable putting IV"s in older kids but I'll take that screaming 6 month old!I'm a peds nurse (a new one! ) and I will NOT stick a baby. LOL... not yet.