Scalp IV's

We do not use many scalp IVs on our peds floor, often adequate access is obtained in one or two peripheral sticks. ACs are great on peds and if not walking yet the saph. vein is also a good option. We make a nice cover for the site, so it's not such a temptation to play with. The times that we do use scalp veins are emergent ones in which quick access is needed or if long term iv abx treatment is going to be needed. If the iv is just needed for hydration, our docs usually will order a feeding tube to be dropped if iv access cannot be obtained. This sounds horrible too, but the parents often request the feeding tube if offered the choice between it and a scalp iv. Personally, I like scalp IVs, the ones I have dealt with were good sites and lasted the entire hospital stay and I don't think that they caused anymore emotional or physical trauma to the patient than any other IV or invasive procedure.

I always was able to get in an extremity. My favorite was the saphenous. It seemed to stay the longest.

My daughter got rotavirus when she was 2 months old (she was a 35 weeker, so a little small). The girls doing the IVs were collapsing every vein they stuck, and I asked them to just aim for the big honking vein on her scalp (I was a veterinary technician in critical care for 11 years and we went anywhere we could find including the jugular). They looked at me like I was a nutcase! She is 6 now and you can still see the scarred, collapsed veins through her skin on her hands and arms. I'd have given anything thing for them to just go for the obvious vein and quit traumatizing her with multiple sticks (I think it took 3 nurses and about 8 sticks before they got her).

Kathy

I work in the 3 major critical care departments of our children's hospital. In the NICU the scalp is the last resort. In fact we will do a midline many times if the baby is a hard stick. For longterm use we use PICC's.
I think most of the hospital is the same in that scalps are the last resort. We are pretty good at getting them in the extremety.

Developementally, scalp IV's are the best location in newborns. newborns bring their hands to their mouths as a self consoling behavior, hand IV's are dicomforting. Foot IV's impair flexion, and any extremety with an IV needs to be visible to inspect for infiltration, so swaddling is impracticle.
However, scalp IV's absoloutly freak out parents, so I only try them if the parents are accessible to explain the rational.

Had a baby once that had had Intraventricular Hemorrhages; his ventricles were worrisome for possible hydrocephalis.

We had to put a scalp vein IV in him, when mom came, she was horrified, g'mo, watchng outside the window was gesturing to pull it out!!! They thought we were somehow putting MORE extra fluid in his brain!!

Took a bit of 'splaning to convince them the IV was not going into his HEAD, just his scalp, and there were a few layers between the IV and the ventricles! After that, I always emphasized to parents exactly where the IV was.

In any case, I agree, sometimes the scalp is the best site available, esp. on long term pts--you've used the others, or they need time to heal.

I have a problem w/hand IV's in NBs--people try to tape their fingers flat. Can we say "grasp reflex"?? The baby, in his struggles to curl his fingers, sometimes pulls his hand right out of the IV. Or the fingers are curled under and taped there good and tight for a day or more before someone rescues them. Put that little hand @ the end of the board so he can "grasp" the board! If the IV apparatus juts out, build it up w/cotton and a med cup to protect it!

I also don't like when the IVs in the hand and the baby is scratching himself waving it around.

There's advantages and disadvantages to almost all the sites, but ya gotta do what ya gotta do!

I've said it a million times; I would request a scalp IV if it were my child. Much more comfortable for the baby.

Hello Everyone - I'm not a nurse - I joined this blog to ask a question.. Our child had an IV placed in the scalp in the NICU and once we got home we discovered a bump on his scalp.. at the site of the IV i'm assuming.. We spoke with the docs - and they didn't seem concerned... its just calcium deposits... they said.. But a month later this bump is till there... Is this common in your experience...???? Does anyone know how long it takes for this bump to go away? I would really appreciate your input.

~ concerned Mom ~

Bella

Thank you !!!

Sorry, we can't give medical advice o this forum. Best to call the doc and ask them these questions.

The first time I had to put a scalp IV in myself, I was horrified. I quickly came to favor that site if it looked to be the most favorable option. I also had good luck with them holding out longer. However, I always tried to explain to parents prior to insertion to minimize the trauma of seeing it the first time.