Quote from jbumgardner4
To whoever said 10 is too old to hold down, some children have had traumatic events happen where needles absolutely terrify them. A couple of children very close to me were traumatized by a dentist who claimed they had cavities and needed to remove them right then and there. The dentist injected anesthesias into their gums and the screamed and cried for the dentist to stop, but the dentist told them it didn't hurt and they needed to stop. Now one of these children has to be held down when getting immunizations at check ups...
BTW another dentist they were referred to said they did not have any cavities, so watch out for those dentists!!
Where the hell were the parents? Consent forms?
I also don't agree that the best way to handle a child who has been traumatized by medical procedures is to hold them down and force them to endure more medical procedures against there will. That child needs counseling, not to be restrained and further traumatized.
To answer the OP- every kid is different. Some are great with needles and some are terrible. I once had to help start an IV on a 6 year old and needed 4 nurses and Child Life Specialists to keep her still. Just the other day I stuck a 4 year old who barely moved and played a video game through the whole thing.
For babies and toddlers, please please please take your time choosing a vein. Use a tourniquet to assess the ACs, hands, and feet. The saphenous vein can be a wonderful place to get labs (or even an IV) in children who appear to have poor access. Unless you really think you can get it, don't try. EMLA cream or lidocaine is a good option, if you have the time. And remember that if a kid has been sitting in the ER waiting room for an hour, you've probably got time to wait for EMLA.
Explain to the parents what is going to happen. Let them know that there's a chance that you might have to stick more than once. Most labs can be run with far less blood than what they require for adults. We rarely send more than 0.5mL per lab test. CBC, BMP- you shouldn't need more than 1mL of blood.
Heelsticks can often be done to obtain blood specimens in young children. This is how all of the labs are collected on healthy newborns in the nursery. Again, 0.5mL per test is usually what's needed. It can save your from trying to stick a tiny vein, and save the child some trauma.
For older toddlers and young children utilize distraction. Explain what you're going to do in simple terms. Use TV, cell phone games, toys, etc. to keep their attention during the procedure.
Once you've got an IV in these kids, please secure it as best as possible so it doesn't fall out or can't be easily pulled out. But PLEASE don't wrap it so well that it's impossible to assess the site. I can't tell you how many kids have been transferred to our facility with infiltrated IVs that wasn't noticed before arrival because whoever started the IV wrapped it with gauze like they were trying to mummify the kid. Transparent dressings over the insertion site. An arm board if the IV is in the AC or hand. A sock over the hand works great to conceal IVs from babies and young children but allows for easy removal and assessment of the site.
For school age and older kids, tell them what's going to happen and why. Don't ask questions like "Can I draw your blood" because they don't have a choice. If they do have a choice about something (maybe they have great veins and can choose which hand they want the IV) then give them the choice. Show them the equipment beforehand if they want to see it. Use distraction (age appropriate) for these kids as well. Sometimes having a conversation about school or a TV show helps keep their attention off their anxiety. Do have someone there to help stabilize the extremity. Even the most cooperative kid might flinch when stuck.