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Jan 03, 2009, 12:19 AM
 Re: Pediatrics Question
I'm only a student replying here and not replying from experience, but from what I've learned getting the parents involved and using comfort holding seems to be the new thing. For IV insertion position the child on the parent's lap with legs danggling across their thighs so they can kick easily without moving the arm. If the child does not want to watch, parent places one arm over the child's midsection to stabilize them, and the other hand on their forehead with head facing away. The arm is placed on the table for nurse to insert the IV. If another team member is needed, they can distract the child with a book, stuffed animal (based on child's development age) or to immoblize the arm. As far as you, and again not speaking from experience since I'm a student, but what I would do if I was in that situation is focus on the task at hand. Let mom or dad (or another nurse or volunteer if parent is not available) calm the child and worry about that. You should focus in on your skill and that alone. Try your best to drown out the noise focus on your hand and that vein. Use guided imagery if you need to to imagine a successful stick with the needle going into the vein the first time. Those are my thoughts, hope it helps
 | | No. 2 |
Jan 03, 2009, 01:11 AM
Re: Pediatrics Question Originally Posted by godfatherSN  I'm only a student replying here and not replying from experience, but from what I've learned getting the parents involved and using comfort holding seems to be the new thing. For IV insertion position the child on the parent's lap with legs danggling across their thighs so they can kick easily without moving the arm. If the child does not want to watch, parent places one arm over the child's midsection to stabilize them, and the other hand on their forehead with head facing away. The arm is placed on the table for nurse to insert the IV. If another team member is needed, they can distract the child with a book, stuffed animal (based on child's development age) or to immobilize the arm. As far as you, and again not speaking from experience since I'm a student, but what I would do if I was in that situation is focus on the task at hand. Let mom or dad (or another nurse or volunteer if parent is not available) calm the child and worry about that. You should focus in on your skill and that alone. Try your best to drown out the noise focus on your hand and that vein. Use guided imagery if you need to to imagine a successful stick with the needle going into the vein the first time. Those are my thoughts, hope it helps.
I'm another student replying to this but as someone who was a phlebotomist when we had to draw blood from children this technique that GodfatherSN mentioned is what we used to get blood. In my opinion, drawing blood from children is more difficult then drawing blood from adults (even without the distracters) just because I found it harder to get their veins and I was so worried about hurting them that it would cause me to miss. I think its getting over that mindset which helped me when it comes to drawing blood from children. That's just speaking from my experience, hopefully it can help you.
!Chris  | | No. 3 |
Jan 03, 2009, 02:55 AM
Updated
Jan 03, 2009 at 03:02 AM by getoverit
Re: Pediatrics Question
Hi Lily,
I don't know where you work, if it's a peds clinic, ER or what. So I'm not sure if you're needing to start IVs emergently or not. And I'm sure a peds nurse will be along here soon and give you some good advice; but for what it's worth, I've started a whole lot of IVs on kids (90% were pretty urgent).
The veins are smaller and like you mentioned the crying, etc can psyche you out and distract you. If the kid is stable and old enough to understand what you're saying, I always tell them "I can do this real fast in a way that's going to hurt a little bit for just a second if you hold still, but if you move around it's going to make it hurt worse and longer." I also tell them the instant that it's over so they can relax.
I think the distraction thing for them doesn't work much, because they KNOW when they're stuck and nothing really takes their mind off it. Not many kids want to watch you, or look at a book or a stuffed animal...once the needle hits them, you have to be ready for them to squirm. that's why speed and firmly immobilizing your site are two keys to a good stick. If they're stable and the parents are in the room, to be honest I usually ask them to step out for a second or help hold the child down. I wouldn't want the child on the parent's lap. the drawback is that whoever has the needle also needs to be firmly immobilizing the site. because if you don't, there's just too many hands in the way. Unless you're using the saphenous vein for some reason, which is fairly large and I've used in a pinch (e.g. trauma, hemorrhage, cardiac arrest etc.)
Also just like any IV start, the more fishing you do and slowly poking around: the more difficulty it seems to bring. Just do it in one, quick stick and get it over with as fast as you can. and it may sound dumb, but just ignore the screaming and crying because if you ever have a kid that doesn't holler and wail, then you'll have a good story to tell people later!! Just think about the vein and keeping the child still.
I hope this may help somewhat and if a peds nurse comes along and tells you something totally opposite from this, then ignore me and go with them! Good luck!
| | No. 4 |
Jan 03, 2009, 08:47 AM
 Re: Pediatrics Question Originally Posted by godfatherSN I'm only a student replying here and not replying from experience, but from what I've learned getting the parents involved and using comfort holding seems to be the new thing. For IV insertion position the child on the parent's lap with legs danggling across their thighs so they can kick easily without moving the arm. If the child does not want to watch, parent places one arm over the child's midsection to stabilize them, and the other hand on their forehead with head facing away. The arm is placed on the table for nurse to insert the IV. If another team member is needed, they can distract the child with a book, stuffed animal (based on child's development age) or to immoblize the arm. As far as you, and again not speaking from experience since I'm a student, but what I would do if I was in that situation is focus on the task at hand. Let mom or dad (or another nurse or volunteer if parent is not available) calm the child and worry about that. You should focus in on your skill and that alone. Try your best to drown out the noise focus on your hand and that vein. Use guided imagery if you need to to imagine a successful stick with the needle going into the vein the first time. Those are my thoughts, hope it helps I am a pediatric ICU nurse, and kid IVs are something that takes practice. The veins are smaller, and the patient is much less apt to be agreeable to what you're doing. My best advice is do it and get it done. You can't talk a 5 year old into anything when he sees that little 24 gauge as a jousting spear, because that's how 5 year olds roll. Parents can be a help or a hinderence, IMO. If mom is able to stay cool for the procedure, by all means have her stay. If she's falling apart worse than your patient, have her step out. I never place a patient in a lap for IV starts. You can't put your trust in a parent who really is just as stressed as their kid, even if they don't show it. They should be supine on the exam table/bed, and no matter how old they are, cover those legs and never let them kick freely, the chubbiest toddler can reach above their head with his toes and screw up your IV start. The calmest teen will freak out and try to run. Any kid under the age of 5 could probably be papoosed with a blanket to protect themselves and you. As for your nervousness, all I can say is that it will pass with more experience in pediatric IV starts, just stay on focus, papoose that kid, pop that IV in, and go on with your bad self, you'll do great! Hope that helps! | | No. 6 |
Jan 03, 2009, 11:35 AM
Re: Pediatrics Question
Totally agree with kessadawn. Kids are challenging to start IV's and get labs on. I tell them matter of fact, try to get them to voluntarily stay still (depending on developmental maturity), get all my supplies ready, tell them that so and so will help them stay still so it doesn't hurt more and then just do it. Parents, in or out I give them the choice and sometimes will ask them to leave depending on their demeanor and how the interaction is with the child. Swaddling really works . Also if there is time (or I anticipate a iv) I wrap their arms with a warm blanket to help the veins pop. There are times when mom or dad will have to hold, but I haven't found that to be too bad, they also comfort so I am the "bad "guy. I too have found lying them on the bed/strecher to be the best, parents' lap, I'm not sure about that.
| | No. 9 |
Jan 04, 2009, 12:08 AM
Re: Pediatrics Question
I've moved this thread to the Pediatric Nursing Forum for more replies.
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