IVs on baby-Am I too sensitive? - page 4
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... Read More
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 turnforthenurse, BSNIt 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_bread, RNFirst 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.
Apr 29, '12 by NicuGal, MSN, RNI 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!
Apr 29, '12 by NotReady4PrimeTime, RN 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.
Apr 29, '12 by ~PedsRN~, BSNI 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.
Apr 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.
Apr 30, '12 by umcRNdeleted double postLast edit by umcRN on Apr 30, '12 : Reason: double post