pediatric venipuncture

  1. 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 don't have too much a problem with the toddler's but the babies are so intimidating especially if you miss the first time and the parents are breathing down your neck. i totally empathize with the parents reactions when it takes 2 or 3 nurses to get an IV. but what can you do if the child needs it? any suggestions you guys can give will be appreciated.
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  2. 14 Comments

  3. by   suzanne4
    24 G angio, I try not to use a tourniquet for the hand, can actually use my hand as one. Have the best results that way. A plastic med cup with a piece cut out is great to put over the site to protect it. And make sure to tape it well.
    If the infant is very young scalp veins can be very handy. For these it is preferable to have the parents leave the room, for any type of IV or blood draw I try to advise it. Rubberband as a tourniquet placed mid-forehead also is helpful. Put a very small piece of tape at one point. As soon as you get the IV in, just cut the rubberband over the tape. I find this way easier than having another person trying to use their hands as the tourniquet. This is just what has worked the best for me over the years.

    Good luck....
  4. by   traumaRUs
    With infants - I prefer the AC or scalp veins. Saphenous is good choice too. Like Suzanne - sometimes I just tourniquet the extremity myself or have my holder do it. Takes practice....
  5. by   Darlene K.
    I also prefer the hand or scalp in the infants. You also need a good holder. If the parents are in the room, I try to give them an active role in the procedure. I usually tell them that their job is to talk to and comfort the child/infant during the procedure and (unless I'm doing a scalp vein) tell them to maintain eye contact with the child. I know other nurses prefer the parents to leave the room (and that's fine) but 99 percent of the time this works well for me.
  6. by   Stitchie
    I don't have much experience with starting IV's on toddlers but I did have to do one and the child was so tired he didn't grumble much.

    I assisted at the Level 1 trauma center where I used to work and the RN took 6 or 8 tries on the kid...I was turning green. Dad was comforting the child and mom was busy passing out in the corner. I told her that she didn't have to watch if she didn't want to ... and boy she didn't want to!

    Not worth a whole lot, but it was an 'interesting' experience.

    Good luck, it does take practice.
  7. by   Kyriaka
    I dont know if this is available to you. But I have very tiny veins. One time the nurse just could not find one so she brought (from Peds I was told) a metal box and I put my hand on it. She turned it on and a light came up through my hand. It reminded me of the light to see an xray.

    Since then I have never seen it or heard of anyone else having this done. But it was great!

    I dont know if she just improvised but someone ought to patent that.
  8. by   purplemania
    don't allow the parent to hold while you stick. They will let go at the most crucial moment. As for "how to", you have gotten good responses but no one addressed cathlon sizes. The Am. Heart Asso. has stated that 22g is sufficiently large enough to infuse blood without lysing. 24 g is what we use the most, for medication purposes. Also, if you have a safesite extension (about 4 in.long and attaches to the cathlon) put one on the end of the cathlon, then loop it beside the IV site and tape securely. That way, when you attach a syringe or IV tubing you will be manipulating the extension, not the cathlon. This will help keep the IV site stable so you don't have to re-stick the little one.
  9. by   Kyriaka
    Ah...I found something similiar!

    http://www.veinlite.com/
  10. by   kc ccurn
    Quote from Kyriaka
    I dont know if this is available to you. But I have very tiny veins. One time the nurse just could not find one so she brought (from Peds I was told) a metal box and I put my hand on it. She turned it on and a light came up through my hand. It reminded me of the light to see an xray.

    Since then I have never seen it or heard of anyone else having this done. But it was great!

    I dont know if she just improvised but someone ought to patent that.


    This does work well for finding hand veins. I also like foot veins. Whichever site you get, just make sure you secure it very well!!!

    I also try to NOT start an IV in their thumbsucking hand if possible.
  11. by   Jolie
    Quote from Kyriaka
    I dont know if this is available to you. But I have very tiny veins. One time the nurse just could not find one so she brought (from Peds I was told) a metal box and I put my hand on it. She turned it on and a light came up through my hand. It reminded me of the light to see an xray.

    Since then I have never seen it or heard of anyone else having this done. But it was great!

    I dont know if she just improvised but someone ought to patent that.

    You are describing a transilluminator. They are very helpful with chubby infants whose veins are not visible to the naked eye. Be sure that you are using a "cool" light, as some of them heat up and can cause burns if left in contact with the skin for too long. In a pinch, a bright penlight in a darkened room will do.
  12. by   Kyriaka
    Quote from Jolie
    You are describing a transilluminator. They are very helpful with chubby infants whose veins are not visible to the naked eye. Be sure that you are using a "cool" light, as some of them heat up and can cause burns if left in contact with the skin for too long. In a pinch, a bright penlight in a darkened room will do.
    __________________
    Give me an IV in the hand any day! Because then maybe I only get 5 misses vs. 10!

    Transilluminator..thanks Jolie. I will remember that.
  13. by   UK2USA
    Quote from Kyriaka
    I dont know if this is available to you. But I have very tiny veins. One time the nurse just could not find one so she brought (from Peds I was told) a metal box and I put my hand on it. She turned it on and a light came up through my hand. It reminded me of the light to see an xray.

    Since then I have never seen it or heard of anyone else having this done. But it was great!

    I dont know if she just improvised but someone ought to patent that.
    We use this box quite often in the peds hospital where I work. We call it a 'cold-light', but I am not sure whether this is a manufacturer's name or a nickname passed down by tradition.
  14. by   Pedsnrs2003
    We use 24G or 22G on most of our kids. Our IV of choice is the Insyte Safety IV. We actually had to fight our immediate bosses and go to the DON of the hospital to get these. They were changing our needles to the Introcan (Introcrap) needles. The Insyte's are highly polished and we find that they do a great job. We also use what we call a "house." Website www.ivhouse.com . These are great and allow our kids to be kids without some of the worry about them tearing it out when they sleep or get more active. We always tape the hell out of them.

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