In my 2+ years of ED nursing, I've started a bunch of lines... probably 1,300 or so and I'm now facing a situation which I'm not sure how to approach.
My kid has had a variety of health issues and been stuck lots and lots of times beginning with her day of birth as a 27-week preemie. About three years ago, a pediatric anesthesiologist took 3 tries to get a line and a couple days ago, now at age 11, an oral surgeon punted after 3 failed attempts.
Unfortunately, there's no ultrasound nor even a venoscope...
Any suggestions how to best prepare for a successful start?
I'm thinking something along the lines of spending the day pushing PO fluids, going for a run, and then hopping into a warm shower... maybe even some PO valium to help her calm down and reduce sympathetic peripheral vasoconstriction (she'll already be prepped with EMLA).
Any other ideas how to plumpen those little spaghetti veins of hers?