Quick question about ivs and young children....

Specialties Pediatric

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Specializes in Float pool for 14 months.

I am a fairly new nurse. I have been workin for 15 months as an RN. I recently switched to a different hospital and went from a place where I floated, there was no peds at all in the last hospital. I switched to the ED, and we have a huge ER with a tremendous pt load coming in. As I have never had any experience with peds before, I was terrified to be put in peds to begin with. Today I had a different preceptor, it was only my 2nd time in 6 wks in that area. I was sacred as all get out today when I had to put an iv in a 22 month old. My preceptor said she would do it, but I felt that I was kind of forced into it. Thankfully I got it in on the first try, that was basically a miracle bc the youngest person previously I put an iv in was 16 and she had huge pipes. Is there any time where u would feel uneasy about putting in an iv in a child and ask the pa or doc to do it? Any tips on how to successfully put an iv in such a small child, while also drawing bloods at the same time? Thanks in advance!

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Specializes in Pediatric Cardiology.

You should put this in the pediatric forum. They would have more input.

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Specializes in ICU, PICU, School Nursing, Case Mgt.

I did PICU, PEDS and PEDI ER for years.

THere is no magic formula, it can be a real challenge. I would say, make sure you have real good, sharp iv caths. We used Jelcos for years however, they did not have the safety factor on them so they switched shortly after I left.

If possible, and this will sound cruel and I really really do not mean it to be, have the parents leave the room. It is much more nerve racking when they are there and hovering. Also, when the parent is not in the room, the child does not associate the unpleasant experience with mom or dad...they can swoop in with hugs, kisses and reassurance as soon as it is finished.

IT goes without saying, have another nurse help...if only to hold and hand you things.

and like almost everything...practice, practice, practice.

When I first started in PICU many years ago, all of the other RNs knew to come and get me if they needed a new line.

Also take your time in assessing for as good a vein as you can find. It is worth taking a few extra minutes to avoid sticking the kid multi times. Although at our hospital we only did two sticks before having someone else try.

In conclusion,as far as asking the Doctors to do it for you, our Pediatric Intensivists always had the nurses do the IVs...they thought we were much more proficient at it then they were....and they were right!!!!:)

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IVs are a skill that some people, for whatever reason, never get really good at. If you are someone who has good IV skills with adults, then it will just take some time to get comfortable with kids. If you aren't great with adults, then you may never be good with kids and will need to get help when necessary.

That said, I would rather start an IV on a kid than an obese adult who has no veins, or an elderly person whose veins blow with each stick. Kids usually have great veins, just smaller. The hardest part of doing kids, in my opinion, is holding them still enough to get the catheter in.

I agree with taking your time to find a good vein. Also make sure you have as many people helping you hold the child as necessary so you can get the IV and the child is not injured. Beyond that, it will take doing a few to get really comfortable with it. Don't be afraid to try, but also don't be afraid to ask for someone else to try if you have trouble.

Oh yeah, I agree with the other post that nurses are more proficient at starting IVs. Think about how often a Dr. starts one (virtually never, not including anesthesiologists) compared to nurses and you'll see what I mean.

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The bevel-down technique

This guy's a good writer and I enjoy his blog (A Day In The Life of An Ambulance Driver) lots of good stories, and does throw some good technical posts and links to his other writings, even though mainly EMS stuff.

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Specializes in RN, BSN, CHDN.

Moved to pediatric forum

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Specializes in Float pool for 14 months.

Thanks for all your advice. I'm getting better with adults, still not the greatest, but I know I will eventually get better. Working in the ER since everyone gets lined and labbed you do it so often that u can hone ur skills. I would rather do a child rather than an adult with veins that blow at the drop of a dime......it all comes with time. I hope oneday to be the person other nurses call to get a line on a child. I just found it tough to draw blood from it bc 24s are so short and hard to get any blood back, enough to send out for labs I mean.

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I work on a peds med/surg floor and on all new admissions, the doctors have to draw labs & start IVs... after that, it falls on nursing. However, we are lucky enough to have doctors that are willing to help you out. If I know I am not going to get an IV on a dehydrated chubby 10mo & its 3am, the kid is screaming, the parents are upset, I will page the doctor to see if they can try. Otherwise, we as nurses have to try once before we call the docs. I haven't been a nurse that long & I get extremely nervous when it comes time to start an IV on anyone less than 5yo but I just bite the bullet & go for it... more times that not I have been successful. Its just a matter of getting experience. :nurse:

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Specializes in Float pool for 14 months.

Down in the peds part of the ER, they don't even have many nurses who like to work with the peds. I'm assuming bc they don't feel comfortable. I got an iv on the 22mo old the first time, and that was my very first stick on a child period. I just went right for it, although I was nervous as all get out! I eventually wanna be a peds nurse, so there was no time like the present to try. My preceptor for the day, held the childs arm and walked me through it. I mean I have to learn bc I don't want to have to depend on anyone even a dr, pa, or another rn to do it for me. Then right after that I got an iv on a 9 year old. I know that doesn't sound like a big deal, but I was proud of myself and it was a real confidence booster. Plus, I couldn't have asked for a better 9 year old. Her dad had left the room to make a phone call. I asked the little girl if she wanted me to wait for her dad, and she was a brave little soldier and said no. Until I get more proficient, I am instituting a one try policy on myself, bc I don't want to frighten the child or the parent.

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I have been a pedi er rn for 2 yrs now (since graduating). When I first started I was afraid of iv sticks. Now I get 90-95% of my sticks. My best a 10 day old very dark skinned pt. Some knowledge that I can pass to you is;

-if you think the are going to move take another rn/ tech with you to hold

- always use a heat pack on your sites ( I always try hands first but also heat pack ac's at the same time)

- take your time. Place band on pt. Look at each hand if nothing Is therenthen look at ac if noyhng there look at the feet

the heat brings the blood to the surface.

-hold their hand firmly in yours. Their fingers shouldbe in your palm and you brace each side of their hand by your thumb and index finger

- get your floor to invest in a "wee sight" $ 90. It illuminates little ones veins so you can mark them or do a stick in the dark.

Heating them up is the easiest and best option

also look at your veins their veins are roughly in the same spot just smaller. I do almost all my I've in the hands and then board their arm if they are really little and use lots of tape

also you can papoose the pt in a sheet and roll them up like a taco with the arm out that bells. The parent can lay beside them on the bed for comfort

we never ask the parents to leave not even in a code. Parents and pt feel better when both are together.

Good luck

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