Blood draws/SL on kids < 5 yo

[JessicaSN]

I think I am pretty good at drawing blood and starting lines on adults and young kids but I'm not so good yet with the little ones. There are 3 main problems: 1. Their veins are so tiny! I always go for the AC site but even still sometimes I don't feel a good one (especially if they have V/D). 2. They move around like you are stabbing them with something sharp I always get a 2nd nurse or tech to help me hold them down, but you guys know how strong kids can be. 3. The evil eyes from the parents when you miss. I feel bad, obviously, to cause pain to a kid and then have to get someone else to try. I can definitely feel the tension in the air when I apologize to the parents after a miss :zzzzz

The youngest patient I have successfully drawn labs from was a 13 months old last night. I did it on the first try and didn't have to "roam" at all. The parents were really happy and I got a compliment from one of our senior doctors

So, does anyone (ER nurses or pediatric nurses too, if you lurk here!) have tips?

[JD228]

Trying to feel a vein usually doesn't work in the little kids, like several people have suggested, you pretty much have to go for the blue lines. A lot of kids have veins in their dorsal wrist, if you bend their hand down, like you are trying to push the wrist up. (Hard to describe) Usually around the middle you will see a vein. The tip prev posted about having everything you need, in abundance is true, it helps decrease the pt (if they are old enough) anxiety as well as the family's anxiety. Sometimes the anticipation is worse than the actual stick.

If you have parents that you think maybe more of a hinderance than a help, you can always try this approach I picked up from a doc. Tell the parents that in order to focus all your attention on the patient and what you are doing, they need to step out for a few minutes. That is they are there, than part of your attention and focus is directed on them and in order to do your very best job, you need them to step out. Sometimes it works, I think some parents would prefer not to be there but feel like it would look bad if they didn't. I don't know how I would feel, if it were my child. It does add some pressure and certainly some are better than others.

[BabyLady, BSN, RN]

From years of hand sewing when I was younger (it was an obsessive hobby), my fingertips are somewhat tough...palpating something like a vein is very difficult and most of the time, impossible for me b/c I really and truly don't feel anything at all.

I have to rely on sight...so this is a very good thread.

[NotReady4PrimeTime, RN]

Just a note on scalp IVs... make sure it's actually a vein and not an artery! Check the vessel for a pulse and if you feel one, go somewhere else. Recently I had a babe come back from the OR with a scalp arterial line, placed accidentally but working well. The anaesthetist had actually pokes TWO arteries in the scalp attempting an IV, and desided to leave one in as the art line. It worked well for more than a week... but you definitely don't want to be infusing anything into a scalp artery.

[miragal]

Thanks for the advice, I'm a farely new nurse at a Peds clinic, worked before that at Med-Sur for 6 years, so children is all very new to me, and drawing blood at all is new too. I've been working around 6 monthes and still barely sucseed in a stick.What am I doing wrong? I know I tend to get nervous , parents, children sqirming around, if not screaming and kicking. I was told to go in very close to the surface instead of deep, is this true?

What can I do to get better, because the more I fail at it the more upset I get,and fail again and again.I wish I could somehow practice on a doll or something?

[VICEDRN, BSN, RN]

1. float it in.

2. use as short a cath as you can find. 3/4 inch will never thread.

3. don't try to draw from it. vein will collapse.

4. get lots of helpers. get rid of the parents if they can't help.

[canoehead, BSN, RN]

My advice is to go slowly, half speed, and tell the parents up front that you take a long time looking and touching so you get the very best spot possible. No tourniquet, usually the helper will be holding the limb tightly enough to pop veins, and they collapse on me if the tourniquet is too tight. Your helper is adjustable mid-poke if the patient's arm turns blue. Use a chair, and sit if possible for the stick. Get everything ready, tape, arm splint, and have it within arms reach. As you put the needle in be aware that the tiny 24G will give you flash a lot slower than a big 18G, and you won't feel a pop as you go in. It's easy to go through a vein even if you are moving slowly, so if you get a flash and it stops, take the needle out of the catheter, then pull the catheter back very slowly until you see flash again, and then advance it. You should still have blood flowing back, and you've advanced further into the vein than your initial poke, so the IV will work without puffing up.

[brillohead, ADN, RN]

If parents are a PITA or just plain make you nervous when they watch, you can ask them to step out because you "don't want the child to associate Mommy/Daddy with getting poked" -- the parents can come in and give comfort to make it all better afterward.

Kinda like how they don't do procedures/treatments on the child in their hospital room, but rather in a separate procedure room in the Peds unit... this way their regular hospital room is a "safe haven" from all the scary/painful stuff that gets done to them while they are there.