IVs/blood draws

  1. 0
    So I work in the ER, not a pediatric ER...but we do get pediatric patients. Most of the time they come in with a fever with asthma exacerbation, but sometimes we get kiddos that come in for BH evaluations or dehydration. Sometimes the providers order an IV and routine labs. I try to avoid sticking kiddos if I have to because honestly, I dread it. I think part of it is because I don't really know how to approach them when I have to draw some blood or start an IV. The other part is I don't want to them cry or scream at the top of their lungs.

    The youngest patient I stuck so far was a 10 year old. Routine labs for a BH workup. I brought another nurse in to help hold her down. I told her we have to get some blood and she freaked out a little but after some coaxing from mom (and having her arm held in place by the other nurse) I was able to draw all my tubes with no problem. The child did a great job and I told her she was being so brave. That wasn't as bad as I thought it would be. I'm more so worried about the younger ones.

    So, how do you approach kiddos when it comes to this?
  2. 16 Comments so far...

  3. 4
    A ten year old is too old to "hold down".

    It depends on the child. If you tell a two year old with cancer who's used to getting his/her port accessed "I'm going to put your tubie in", they may just say "Ok." I have a two year old who sits calmly and even says "I'm not going to cry because I'm brave." The younger the child, the less advance notice you should give them that you are going to draw blood. Use the parents- they know their children best.
    nrsang97, hiddencatRN, poppycat, and 1 other like this.
  4. 3
    Don't lie to them. Don't tell them it won't hurt. As far as using parents, I have always been told to try to avoid that. The reasoning was that you don't want the kids to think their parent was responsible for their pain in any way.

    And stickers. Stickers are amazing for keeping kids calm during unpleasant procedures.
  5. 5
    I also work in a primarily adult ER that gets peds pts. I did peds for years before making the switch and am disappointed at how non-peds aware my facility is. Having child life available to us in the ER would be a big help, but we don't, they only cover our inpt units.

    Distract them with toys/stickers. We have some I-Spy type books that the kids can get focused on.

    If the IV/lab stick is not a true emergency see if you can numb the area first, either with a spray or with LMX (topical lidocaine). You will need to wait about 20 min after applying the topical before you can stick them.

    If you do have a infant or toddler that doesn't understand what is going on and does need stuck, you can wrap them up in a blanket burrito style and leave the extremity you will be poking sticking out.

    Always give the parents the option to stay at the bedside. I have found most prefer to be there with their child.
    nursel56, nrsang97, poppycat, and 2 others like this.
  6. 0
    Quote from KelRN215
    A ten year old is too old to "hold down".

    It depends on the child. If you tell a two year old with cancer who's used to getting his/her port accessed "I'm going to put your tubie in", they may just say "Ok." I have a two year old who sits calmly and even says "I'm not going to cry because I'm brave." The younger the child, the less advance notice you should give them that you are going to draw blood. Use the parents- they know their children best.
    The other nurse was more so just holding her arm in place. She kept moving and without her arm being held, I definitely would have missed. Mom couldn't really help because she was across the room in a wheelchair. Our ER rooms are very small so there really wasn't room for her to be at the other side of the bed, she just spoke to her daughter during the process.

    Thanks for your tips!
  7. 2
    First,I always discuss the plan of treatment with the parent(s) or legal guardians. I try to do this out of the earshot of the child (if they can understand) because often when they hear the word needle or stick they freak out and I want to approach them separately.

    Then I make it age specific.it would help if you review developmental stages so you can understand how to approach them. You need to know the age of reason for example, so you do not waste your time trying to reason with a child that has not achieved that ability yet. I get all my supplies ready before I approach the child. I explain to them what I need to do and why I need to do it and what I need them to do. This is all age specific of course. If a parent wants to stay I do not have any issue with it but I give them the option...many do not want to stay and if they do not I reassure them I will take very good care of their child. That little statement really helps to reassure them and I truly mean it and treat that child as if they were my own.

    There are many things you can do to aid you and the patient and ease the pain and I use them if clincally time permits.
    turnforthenurseRN and poppycat like this.
  8. 1
    You're not alone! The youngest pedi pt I had that I put an IV in was probably 10 months old. I try to avoid sticking them because I really don't look forward to the crying and the anxious parents who always say "we want someone who can do it the first try." It makes the pressure even worse! I guess I'm just glad that I'm not the only one who dread sticking kids!
    turnforthenurseRN likes this.
  9. 2
    I always make a point of telling then that the IV is actually a little straw and that I'm not leaving a needle in their arm. Parents are welcome to stay or go depending on comfort but I never let them hold because frankly, they almost never do it well and a good hold is essential to success. Tell the patient their job is to hold still, and praise them afterwards even if they were demon spawn during the stick. Definitely don't lie about pain: it will hurt but that stops as soon as the IV is in place.
    nursel56 and turnforthenurseRN like this.
  10. 1
    Unrelated, but kind of related. We often get orders to rehydrate kids via IV saline. Well, poking a dehydrated kid is pretty terrible. Recently I've heard that some studies suggest hypodermaclysis (subcutaneous) infusions would work equally as well to rehydrate kids, and with a lot less trauma! I suggested it to a doc a few months ago, but he didn't want to try it.

    Do any of your centers use this?
    turnforthenurseRN likes this.
  11. 0
    I've read about subq fluid but have never seen it used. For dehydration cases the docs almost always want electrolytes drawn and we potentially will be giving other medications too, so perhaps the concern is that is doesn't save them sticks in the end?


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