Best way to start IV on infant or child

NessaNurse · Sep 18, 2009

Warm packs help. A good helper to help hold and hand you stuff..little guys are wiggly! Always have everything ready to go before you start. For little babies I like feet esp inner ankle. For older kids most of the same places you would find as in adults. And once you get that IV started...SECURE IT! Always make a loop and place you tape well, dont cover over your site though with peds you really need to assess the site to make sure its still good. Don't be afraid to practice, start on the biggest easiest kiddos and work your way down to the harder kids and babies (chubby ones are really tough IMHO).

iluvivt, BSN, RN · Sep 18, 2009

I can give you so many tips....so when I get home (at work now)..I will write out all my tips that will make you a success

newtress, LPN · Sep 18, 2009

Iluvivt, you can't see me right now, but I am bowing my head in supreme appreciation to you for your supportive post. I look forward to your words of wisdom on this mind bending fear. All I see in my head is pristine perfect brand new plump skin, that in my mind won't let a good blue highway show me where I need to go.

MikeyBSN · Sep 18, 2009

Yeah, I'm really good at this. The first thing you will want to do is introduce yourself to the family. Say, "Hi I'm nurse _____ . I just graduated nursing school and this is my first day." Next, you want to restrain the baby. Normally, you could use some leather restraints, but they are usually too big. A good alternative is to find a nice belt to tighten. If you work in an old hospital, you might be able to get your hands on a straight jacket.

Once the baby is secure, it will cry. If it's an older kid, tell them that it hurts more when you cry (this will get them to stop). Next, tie a band tightly across the upper arm and give the lower arm a few random smacks. By this point you should take the needle out and start waiving it around in front of the kid's face. Say something like, "the doctor is making me jab you with this and man is it gonna hurt" (deflect the blame).

By this time the mother will ask you how many times you've done this. Your answer to this question is always, "You mean on an actual person?" The kid will start to look at you with those tear-filled puppy-dog eyes. At this point you need to place two gauze pads over the kid's eyes and tape them there (make sure you showed the kid the needle first).

Now you are ready to go. You should look first at the wrist just proximal to the palm, this is the most sensitive area and hurts the most. If you don't see anything, try digging around a little with the angio, the first stick is just practice anyway (try not to hit the radial or ulnar artery). If that area fails, some kids have great scalp veins. Once you get the IV in, let the kid up. Tell the kid that if they pull the IV out you'll have to put a new one in their eyelid. Hope that helps.

voraciousj · Sep 18, 2009

Oh boy MikeyBSN...

That was too funny:yeah: :jester:

kwantiko · Sep 18, 2009

Yeah, I'm really good at this. The first thing you will want to do is introduce yourself to the family. Say, "Hi I'm nurse _____ . I just graduated nursing school and this is my first day." Next, you want to restrain the baby. Normally, you could use some leather restraints, but they are usually too big. A good alternative is to find a nice belt to tighten. If you work in an old hospital, you might be able to get your hands on a straight jacket.
Once the baby is secure, it will cry. If it's an older kid, tell them that it hurts more when you cry (this will get them to stop). Next, tie a band tightly across the upper arm and give the lower arm a few random smacks. By this point you should take the needle out and start waiving it around in front of the kid's face. Say something like, "the doctor is making me jab you with this and man is it gonna hurt" (deflect the blame).
By this time the mother will ask you how many times you've done this. Your answer to this question is always, "You mean on an actual person?" The kid will start to look at you with those tear-filled puppy-dog eyes. At this point you need to place two gauze pads over the kid's eyes and tape them there (make sure you showed the kid the needle first).
Now you are ready to go. You should look first at the wrist just proximal to the palm, this is the most sensitive area and hurts the most. If you don't see anything, try digging around a little with the angio, the first stick is just practice anyway (try not to hit the radial or ulnar artery). If that area fails, some kids have great scalp veins. Once you get the IV in, let the kid up. Tell the kid that if they pull the IV out you'll have to put a new one in their eyelid. Hope that helps.

I have not laughed that hard in a while!

PAERRN20 · Sep 18, 2009

I wouldn't let the idea of starting IVs on peds scare you away. I work in an ER that sees quite a few kids that needs lines. I started as a new grad, and it took me about 6 months to work up the courage to start one on a child. I was able to get it the first stick. Since then I have started IVs on peds many times. I have always been successful. The key is to be confident, even if you have to fake it. There were be other nurses around that can assist you with your first stick. Personally I wouldn't work on a peds floor because I prefer adults. But if this is a floor you'd like, go for it. I don't know how the job market is out you way but if this is the only job offer you have then I would take it. You will eventually learn to start IVs on kids, and if not, you can always move to a different floor when you have more experience.

newtress, LPN · Sep 18, 2009

I have only asked a legitimate question here for tips and guidance on IV start for babies and children. I'm now going to make a legitimate statement about the ficticious spoof on how to start an IV on a child. I didn't find any of it funny in any way at all. I have reservations about it being so new to it, then I read a description meant to be a joke, but for me it read like a horrorible nightmare. Thanks for the inspiring story of the best way to hurt a child and how to be the worst nurse possible. I'm sure it was meant as a joke, but that one flew right over my head.

MikeyBSN · Sep 18, 2009

Starting an IV on a kid can be more challenging than adults (though some adults are big babies). It also depends on the age of the kid. Your teenagers (13 and above) will basically be an adult in terms of IV's, and they usually have great veins, so don't worry too much about them

The school age children (7-12) are usually pretty good. They too have good veins and you can usually get away with a larger bore IV (such as a 20) if they need it. These kids are pretty industrious so you can employ their help. Remember that they will get scared more easily than the teenager, so remind them that the initial pinch is all that will hurt. Show them how soft the collapsed angio is and tell them that the needle will come out. Make sure they know that all of their blood won't fall out. The key is to tell them to stay very still so you get the IV on one shot. If the kid becomes hysterical, it will make things much harder for you so keep them calm. Generally, this age group isn't too bad.

For smaller children (4-7) things become a little more difficult. You can try to explain things to them and some are good and others aren't. You should have mom help you by getting ready to hold the kid down, even if they promise not to move. Make sure you have all of your tape and supplies at the bedside because he will most likely become hysterical once you stick him. You might want to put some benzoin on in case the kid becomes sweaty, that way your tape sticks and you don't lose the IV. These kids usually have decent veins and you can get a 22 into the dorsal hand, forearm or AC. Again, if you can convince the kid to act like a "statue" and not move, it will make things much easier for you.

The "tolders" (18mo-3 years) are probably the most difficult. These kids can't be reasoned with and don't understand what is going on, but they are usually big and strong enough to fight you tooth and nail. Never try to line a kid in this age group by yourself. Employ the mother and get a tech or another nurse to help you. Get all of your supplies at the bedside and have an armboard and a gauze cling ready to go. Wrap the baby's legs and one arm in a folded sheet or blanket, tell her you are going to play the "mummy" or "hot dog" game. The kids usually trust you at this point. Tie a band high on the arm, but start looking at the dorsal hand. Most kids in this age group are plump so finding a vein can be tough. Be sure to feel as well as look. Try rubbing a chloroprep or alcohol hard against the skin, this sometimes makes some veins pop up. The hand is the best bet, only use the AC if necessary. The IV's easily fall out of an AC in a kid and the kid can almost always twist that part of their arm, no matter how tight you hold him. This makes it very difficult to get the IV in. Stick with the hand. You'll only have one good shot to get the IV in. If you miss the first time, the kid will become hysterical and hate you. This makes it much more difficult to get the IV in. You should always use a 24 and a syringe. Once you get the line, secure it right away and place an arm board on the pt. Cover the IV tubing with the cling, but leave a part open so you can see the tip of the angio to assess the site.

Babies (>18 mo) are hard because their veins are tiny. However, you can usually find a good vein on the dorsal hand. If there is no vein that you can see or feel, try to use a "weelight". If you don't have one, you can use the otoscope and place it behind the hand to see if you can find a vein. If you don't see one, try the foot. Personally, I find more veins in the babies' feet than in their hands or arms. Avoid the AC unless 100 percent necessary. Always use the 24 and secure it like you would a todler's IV. If all else fails, tell the doctor to do it.

MikeyBSN · Sep 18, 2009

I have only asked a legitimate question here for tips and guidance on IV start for babies and children. I'm now going to make a legitimate statement about the ficticious spoof on how to start an IV on a child. I didn't find any of it funny in any way at all. I have reservations about it being so new to it, then I read a description meant to be a joke, but for me it read like a horrorible nightmare. Thanks for the inspiring story of the best way to hurt a child and how to be the worst nurse possible. I'm sure it was meant as a joke, but that one flew right over my head.

I've posted a legitimate answer for you.

newtress, LPN · Sep 18, 2009

I thank you, and with all due respect you know exactly what I was inquiring about. I think peds nurses deserve IV hazzard pay! Man o man this is going to kick my a$$. But at least you are pointing out that the dorsal hand is the #1 sweet spot. By the way, when you talked about using a syringe, you weren't talking about floating the cath in right?