IVs on baby-Am I too sensitive?

Specialties Pediatric

Published

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 were attempting to start the IV. I am very traumatized but here is what happened:

Strap baby down on table across the chest and legs. Baby is wiggling a lot and rubbing herself red where the restraints are. She's screaming crying. They tie the tourniquet and baby screams and cries even more. Arm turns red and face turns red, no tears bc baby is dehydrated. IV is inserted and baby gasps for air and screams harder and keeps turning her face. There is no blood return so the nurse wiggles cath around. This goes on for about 15 secs-I removed the tourniquet bc they forgot to. They decide the IV is useless and they take it out. This took about 3-4 mins. They find another site and attempt again. this time they mess with the IV for about 4-5 mins bc it has a kink in it but it is in the vein. Baby is reacting the same way and I'm getting worried bc she has been crying like this for about 10 mins, rubbing herself raw against the restraint and she is continuously red from crying. They finally decide to take the IV out. I take the restraint off and sit the baby up and try to comfort her. They joked that they are cold hearted and they can tell I'm new. They want to attempt her legs now. So we lay her back and begin again. This goes on for about 20 more mins. They need more supplies so I leave. I asked if I should get a paci and they said it wouldn't help. I got one anyways. I come back and had some water so I could keep dipping the paci in it bc I noticed the baby's lips were now chapped and her mouth had no moisture. The baby keeps falling in and out of sleep these last few times which lasted about 15 minutes. The baby only had two very very small breaks (about 1 minute each), we were in there for 45mins to an hour, the baby had nothing to drink except what I was offering from dipping water on the paci. I am so upset about this. This was over 24 hours and I am so sad. I am going to the mgr and asking about a different process for insertion of IVs on babies. I'm new to the unit and hospital and I don't want to overstep but I feel this could have been done a better way.

What do you think?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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. ( :eek: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.

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.

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.

This is a perfect example that many student nurses who wish to work in peds should first hear about...just for starters.

I 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.

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.

Specializes in Research, HIV, Surgical, ER, Primary Care.

I 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 hoorifice/asleep just from being restrained during an IV start--no needles even involved.

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.

My 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.

Specializes in ER, progressive care.

It 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.

Specializes in Cath lab, acute, community.

First 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.

Specializes in NICU, PICU, PACU.

I 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!

Specializes in NICU, PICU, PCVICU and peds oncology.

Many 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.

Specializes in Acute Care Pediatrics.

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! :D ) 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.

I'm a peds nurse (a new one! :D ) and I will NOT stick a baby. LOL... not yet.

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!

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