Pediatrics Question

I have been a pediatric nurse for almost 10 years now, mostly in ER’s.

Some pediatric IV start tips.

-Gather all your equipment and have everything set up on a tray BEFORE you enter the room. Setting up in the room only increases the anxiety time.

-Have the child supine on a bed. Never let them be held on a lap. If for no other reason than for safety. It takes away the up and down movement of a pinned down an extremity.

-To me, a screaming child is a breathing child so it does not bother me at all. (At least that is how I rationalize it.)

-Have a co-worker help you hold down/pin down the child. I still have a slightly broken tooth from getting kicked by a 5 year old whose mom was ‘holding’.

-If the child is 4 or under, don’t bother to try to get them to cooperate by explaining. As soon as they see the needle and realize what is about to happen, all bets will be off.

-DON’T blind stick. If you see a vein and you think you can do it, go for it. But if you are not reasonably sure, get someone else to do it. In time, as you become more experienced, you will gain the confidence and the skills to be proficient. (And FYI, it usually takes a couple of years to become really good at that.)

-There is nothing wrong with allowing parents to be in the room. But if they are going crazier than the child, there is nothing wrong with asking them to leave.

-The biggest mistake I see with newer nurses missing pediatric IV’s is when they go through the vein. Go slow. Once you get blood return, advance a little bit further, if you still have blood return then start to advance the catheter only.

-If you have any doubt about the integrity of a PIV, take it out and start a new one.

I'm gonna have to disagree with you on this one (see my previous post). Yes they cry but I have had great success with even some three year olds holding their arms still with a little explanation and a friend to help "remind" them. Now two year olds and generally ill-behaved kids are a completely different story. I've even heard some who could barely talk drop the f-bomb on me. Yikes!

AND a heart rate (sinus tach!!) and a blood pressure (hypertense!!).

I am working on an evidence based practice project that might help you out. I am finding research that supports the practice of having a parent hold the child in their lap. You still need to stabilize the extremity on a bed. There is also evidence in the research about things you can use to make the IV start almost painless with things such as buffered lidocaine SQ or LMX4. If you numb the site and it doesn't hurt, the child may be calmer. Also using Child Life therapists to distract the child may help diffuse the situation. Some children will cry just because they are being held down. Telling the child about what they will sense shortly before in developmentally appropriate wording can help increase their sense of control. Taking deep breaths and calming yourself first and being prepared helps you and your patient.

This forum is awesome! I've watched a number of IV starts on kids, but as a nursing student, still haven't had the opportunity to try one. At the Children's Hospital where I volunteered, there were a few nurses who would usually be called in because they just had "the touch." Other nurses were good at other things. Cest la vie.

Not a peds nurse, but did my peds rotation at a major pediatric hospital. We used a treatment room for ALL "owies" and parents were never expected to hold the child.

I can't imagine starting an IV on a wee one...some adults are difficult enough and at least they usually understand "why" they need one.

Peds nurse here, here's my 2 cents on it all.
While some think holding in the lap decreases anxiety, I don't feel it's the best position for the actual stick. Supine is the best, safest most secure way to make sure nothing moves anymore than it has to be.
Kid veins are easy to go through, so once you get blood back just advance the needle the tiniest amount and then advance the catheter.
Depending on the age, I give the kids a "job," which is to hold as still as they possibly can. I tell them they can scream, yell, call me names, do whatever they want, just not move. I explain to them that if they move, there is a good chance that we will have to do the stick all over again.
Always bring back up. A parent is not the best holder, nor should they feel like they have to be. Even if it takes 5 people to hold a kid down, hold them down so that nothing moves that shouldn't be moving.
Just like anything else, practice makes perfect. Even if you aren't the one getting the IV, try to take each opportunity as a learning experience. Ask the more experienced nurses for tips and suggestions, or just to watch them do a stick and try to pick up on their technique.