pediatric venipuncture - page 2
hi everyone, i am a new emergency room nurse and we start a lot of IV's on newborns and toddlers. i would like to know from nurses with experience, what is the best place to find veins on babies? i... Read More
Jun 2, '04I work on an infant unit in a large childrens hospital. We use the transilluminator all the time, a pen or flashlight if we're desperate. I like hand veins, feet are ok. Hate scalp veins, as do most of my colleagues( and parents.) We use 24 G insyte, I really like them.
Jun 24, '04I work in MRI, where we do a lot of IVs on infants and toddlers for both anesthesia and contrast infusion. I have a lot of success with saphenous veins. These can be tricky because they are almost always a blind stick and you have to know how to landmark well. I have been fortunate enough to be able to hone this skill in the environment in which I work. I work alongside anesthesiologists who are VERY generous with helpful hints and have the added bonus of doing a mask induction on the child so he/she is asleep on the table while I am finding the vein ( Sevoflurane is also a good vasodilator ). Because of this, I have gotten pretty good at finding the tough veins. Here are a couple of things I have learned about getting into a saphenous:
1. Unless you are dealing with a VERY small infant, you will usually find that a 22g needle is best--even if most of the child's other veins are 24g sized. This is because the saphenous can be a little deeper especially with those chubby kids.
2. Landmark using the medial malleolus. the saphenous vein is located between the medial malleolus and the extensor tendon (not sure of the exact name of that tendon, but it is the one just lateral to the ankle bone)
3. The vein is curved just distal to the ankle, so you will most likely have the best luck advancing the catheter if you go in just at the ankle and advance upward.
Double check this with your IV nurse or nurse educator, but these tips have helped me.
Also, with regard to hand veins...
They will roll less if you grip the hand with the child's knuckles and fingers between your thumb and middle/ring/ pinky and bend the child's wrist slightly downward . The wrist should rest between your index and middle fingers. This should form a "C" with your thumb and index finger on the back of the child's hand and not only give adequate traction, but immobilize the hand as well.
Hope this helps!