Assessing Pediatric IV sites

AirforceRN, RN · Oct 1, 2008

I would think if there was truly no redness, swelling and good blood return, the IV itself is probably fine...but kids, especially littleuns are often freaked out by having something jammed in them and taped there. I try and keep a clean IV cath with me so I can show the kids what is in there (ie not a big metal stick but a small plastic straw), keep it well padded and depending on the infusion...keep the rate slow and steady.

wanttobeanavynurse · Oct 17, 2008

Does anyone have any tips for assessing pediatric iv infusion discomfort when there is no visible swelling, redness and has a good blood return. Any tips for discerning fear and apprehension versus a true IV site complication?:(How do you best explain how an IV should feel to a child of 6-8years old?

I agree with the previous post. The IV is most likely good if there is no swelling, redness, and there's blood return.

Lots of kids freak out with IVs, whether they hurt or not. One way to tell if it's pain or fear is to distract the kiddo- use parents, TV, toys, whatever gets their attention off of the IV. When they're distracted, flush the IV. If they don't react, then it's most likely fine. If they still freak out, even when distracted, the site proabably hurts, and the IV could be going bad. Hot packs help with the pain.

For explaining IVs to a kid (assuming it's an IV that's already in), I tell them that sometimes it can feel cold, and some kids can even taste the saline or heparin flushes. 6-8 year olds get a kick out of the taste part....lol.

vamedic4, EMT-P · Oct 18, 2008

Rest assured that you're not alone with this problem. First, consider your infusion. The med you are infusing could be uncomfortable and sometimes (as in the case with potassium or some antibiotics) painful in itself. Some of what we put into peripheral veins are pretty caustic substances, remember that.

Tell the child the truth. When you flush the IV, it should feel cold - they should feel the cold fluid going up their (pick your extremity). It shouldn't hurt. Also, flush slowly, especially with children who have a flair for the dramatic. Those are the kids you have to distract. As others posted, use your parents as distractions, toys, cartoons. If possible, assess the IVs while the child is sleeping. Stop the infusion and flush with saline - observing for infiltrations/redness/swelling/leakage/site soft, nontender, et cetera. If you are slowly flushing and the child wakes up screaming - you can pretty well bet that the IV isn't where it's supposed to be. Remember also, that blood return in itself is no guarantee of IV patency. Just the other day I started an IV on a little one, great blood return, everything looked well. Hooked up the fluids and patient complained of pain at the site - but blood drew back in the T connector tubing. Sure enough, the vein was blown. Rely on several means by which to assess IV sites, never just one.

vamedic4

iluvivt, BSN, RN · Oct 18, 2008

Great advice vamedic4 and I agree totally. The one thing that you should always do on adults and especially children is compare your IV side and site to the opposite side and site and you will find it much easier to detect an infiltrate or other complication. Also ,always know how old your IV site is. Now in peds we will leave them in longer that 72-96 hours without complications wheras in peds we let them go until the first sign of a problem,but you can bet if your site is old and at an area of flexion (and not secured well ) you can anticipate possible problems and assess more frequently.

The next thing you can add to your information is finding out the ph of the drug as anything less than 5 or greater than 9 is going to be more irritating.Ph information is easy to find in a good drug IV book like Betty Gahart.