Blood draws/SL on kids < 5 yo

nurse15dc · Dec 31, 2008

Kudos on the tough stick Jessica! I've only drawn labs and started IV's on adults. I'm sure drawing blood from a sick or dehydrated child would be a lot harder.

ps I'm embarassed to ask a dumb question but what does SL and V/D stand for? Thanks for the info.

pink85 · Dec 31, 2008

Drawing blood on small ones and putting IV's in them are both difficult and mentally taxing! I did pedi for 8 years and most of the time it is a lot of luck!When they are babies they just have so much sq tissue you can't see or feel veins! I had a doc teach me a blind stick to draw blood and it works about 99% of the time. If you take and extend their arm, straight out and supine, so their palm is facing up. The key is to keep their arm straight and aligned, so have someone else brace it for you at the elbow so it doesn't bend. Keeping the wrist, lower arm and elbow all aligned. Then you will do a blind stick about one and a half fingertip down from the AC at an almost 90 degree angle. Practically straight up and down. You will go all the way in and then you will slowly pull out and you should get a flash of blood. You don't even have to use a tournaqet. Like I said it works! For finding veins for an IV you can try putting on the tounaquet and then wiping firmly with your alcohol pad. It blanches the skin and a lot of times enables you to see the vein. I am curious to see some other ideas! Great question Jessica!

pink85 · Dec 31, 2008

I assumed V/D was vomiting and diarrhea. I dn't know about SL!

Editorial Team / Moderator · Dec 31, 2008

We papoose kids in a sheet, usually, and leave the chosen arm out. I tell them we're going to make them into a little baby burrito. :) And we also give the parents the option to leave the room if they're not comfortable with it. Most opt to stay, but some just can't.

Get as many hands to hold that kid down as you can. I always explain to the parents that the kids hate being held still more than anything, which is why they scream their heads off. (The kids that don't fight me during the IV? I worry about them, a lot.) Kids can twist their little arms in almost impossible ways, even with someone holding their hand and elbow still. Spaghetti arms! Once I've chosen my site and I'm going for it, I go in slowly ... too many times kids can jerk unexpectedly, and then you've just gone out the back of their best vein.

It just takes lots of practice, truly. You'll get there. After I successfully started an IV in an 11-day-old kid with a skull fracture while mom, dad, doc, and helicopter transport crew stood over my shoulder, I figured everything else was small potatoes.

annaedRN, RN · Dec 31, 2008

SL - starting lines??

JessicaSN · Dec 31, 2008

Sorry, SL = saline lock :) V/D = vomiting and diarrhea

pink85: Do you go in at the middle of their arm below the AC site? If I can learn your technique it would be amazing!

After I successfully started an IV in an 11-day-old kid with a skull fracture while mom, dad, doc, and helicopter transport crew stood over my shoulder, I figured everything else was small potatoes.

I bow to you :bow: :bow:

flightnurse2b, LPN · Dec 31, 2008

this is something that my paramedic instructor taught us for really tough youngins.

aim for the blue streak. measure the catheter or needle against the vein and make sure you have adequate room. then papoose the child with a helper and aim for the blue streak. once you get a little flash, withdraw the needle and float it in with a saline flush.

i thought it was kinda horrible idea, but it has saved my butt with many hard pedi (and adult) sticks, it does work.

SFRN · Dec 31, 2008

Having started my career in a NICU I have definitely learned some good IV skills....now I work in an adult ICU and starting IV's on an adult is MUCH easier! When I worked in the NICU I would often use my wee-sight transilluminator it worked really well in some babies and you could see veins not visible to the naked eye and ones that certainly couldn't be palpated.

gal220RN, BSN, RN · Dec 31, 2008

1 Before you even touch the kids, make sure you have EVERYTHING you need in mulitples in an organized fashion on a table, blue pad, easily visable. Open you alcohol wipes - lots, flush all your lines AND MOST IMPORTANT, HAVE YOUR SECUREMENT DEVICE READY- either thin strips of tape for chevrons or stat locks (which I highly recommend)

2 On kids with lots of subq tissue, lights will not be that helpful, unless you are looking a thumbs or fingers (good sites for pudgy kids with no veins)

3. Remember to start distally so you can work up as needed. If a child is going to need long term access, you might want to avoid the AC's in the arms so the PICC team can use them for lines

4 If you have a baby, papoosing in probably the most secure, less traumatic means of restraint- and remember your sucrose on a passy for soothing- it works!

5. FYI- my favorite sites for difficult sticks: saphenous veins on the interior aspect of the ankle- they are always there, just have to find them; also along the outside of the foot on the bottom, veins run horizontally along the side and are great sticks. For infants, no question- scalps rule! My personal preference, no rubber bands- just have your helper place a finger firmly, but not completely occluding the vein outflow. This prevents these large, but somewhat fragile veins from blowing. And, not to be stupid, make sure you point the catheter toward the heart. I know, it seems stupid, but I've seen it happen the other way around:nurse:.

Good luck and keep sticking!

pink85 · Dec 31, 2008

Yes you go right in the middle. Right b/w the radius and ulna about 1 to 1 1/2 fingertips down. :nurse: Remember the elbow is facing the bed or table and the underside of the forearm is facing up. Keep the whole arm aligned. Sometimes it is hard to do that b/c they are wiggly but you can use a pappoose board or wrap them in a blanket. Like someone sid earlier it is hard for the parents to understand that are screaming more b/c we are keeping them from moving, not the actual venipuncture! I have used this on kids up to about 14-16 months old. Of course the older the child the longer needle you need to reach that vein. I have never tried it on kids older than that but it may work!:wink2:

PedsED-RN · Dec 31, 2008

Oh, tiny tiny lil veins!! No matter how good you are, some kiddos are just plain tricky. Especially some of the chronic pts we see frequently, like our heart defects and special needs pts with no long-term access.

Lets see...

-Saphenous is great! Don't forget to take those socks off, sometimes you will be surprised what you find!

-Weelites (or whatever equivalent "illuminator" you have, can be very helpful too, mostly for hand/wrists on lil ones.

-I second what was already said about scalps, even though they freak me out a bit too sometimes, just since I know the reaction from parents when they see that the first time. =)

-For ac's, I make sure palm is up, and if I think I feel something, bend arm some at elbow, and see what happens to what you feel......if it disappears, more likely a tendon or nerve. If you still feel it, it is that vein popping out. =)

-the "floating" technique can work well for IV caths, once you get a flash try to advance while flushing, just be careful to monitor for if it blows, or infiltrates if you already poked through the other side.

-I usually avoid the palm side wrist veins, but on some kids, they are easily visible if you have no other options.

-hopefully your facility has proper equipment-24 gauge catheters, we even have 2 lengths: .56 in and .74 in. Sometimes it is really REALLY nice to have that short one!

-Warm packs!

I am sure I can come up with more, but mostly it just takes sucking it up and going for it. I was really uncomfortable when I first started in this job after coming from adults. I was always nervous when poking, and not confident at all. Now I have realized that I can't even hit anything on the 18 yo whose veins I can see from across the room, and some days I am the queen of the tiny blue lines. =)

Good luck and happy poking =)