I know 99% of parents hate them. How do you feel about starting them there?
I was asked to start a peripheral line on an old timer that had nada. I looked at her scalp and there were tons of huge veins! I asked the nurse why she didnt' try there as even a blind GN could have hit those and she said she hated to start IVs there.
I think they're best. They last longer, secure easy, more comfortable for the baby. I'd want it in the scalp first if it was my child.
I'm a nearly-finished nursing student, so this questions I"m asking is not a "challenge" - it's a genuine curious question to this response - why do you feel the scalp is a "dangerous place" if there's extravasation of meds??? Wouldn't the blood-brain barrier, along with various levels of skin, fascia, bone, and still more fascia, protect what's underneath?
Because I've seen areas go completely necrotic, and heard of limbs needing to be amputated from infections that get in those wounds, and that's bad enough on an extremity, but in the head, where you can't cut out a lot, that's worse.
I'm a nearly-finished nursing student, so this questions I"m asking is not a "challenge" - it's a genuine curious question to this response - why do you feel the scalp is a "dangerous place" if there's extravasation of meds??? Wouldn't the blood-brain barrier, along with various levels of skin, fascia, bone, and still more fascia, protect what's underneath?
It is most definately a cosmetic issue. If a bad IV infiltrate occurs right smack in the middle of a babys forehead...they get to wear that scar for the rest of their life. No hair will grow in a spot where there is an infiltrate...so depending on where in the hairline it occurs, that could be very traumatic!
I LOVE scalp IVs because they are huge and will last longer, will not get "kicked out" like a foot IV and I can almost ALWAYS get them on the first poke without the baby even grimacing! That is a lot better than torturing a tiny baby with multiple sticks in the arms and legs anyday!
When starting IVs, I will look at an infant's hands and feet first, but if I don't see any vein that I think I can get in easily, I will start looking at their scalp. Why stick a poor baby six or seven times for a PIV in his hands or feet, if you have a large scalp vein, easily visible, that you can access? It is less stressful for the baby--- you can completely swaddle him, and have someone offer him a pacifier, if possible, while you start the IV you need.
If I have to start a scalp IV, I do a lot of extra parent teaching and support. Explain that the IV is just under their baby's skin; that it doesn't go into his brain. If we have a baby with a PIV, we usually will tell our parents that if the IV comes out, there is a possibility that it may have to be reinserted in his scalp, and why.
If you have to cut some of the baby's hair, be sure to save it for the parents.
I am so glad to see this post I am an emergency RN in a teaching hospital and when we get neonates the MD's refuse to use the scalp veins they stick the child 4-5 times and blow viens before a nurse pushes them away (I believe 2 sticks and you are out, one stick for an intern) I have started a scalp vein when the MD's have blown all the peripheral veins to their shock.I am goingto post this post in front of their area. (by the way the NICU nurses also use peripheral veins first)
My question is at what age can you use the scalp vein till.
I dislike them. I've seen a couple of really bad infiltrates. You know the kind. They look a little red when the nurse realizes it's infiltrated, then turns into a bad burn. Not so nice on a kid's head.
Personally, I seldom see nurses stick a baby more than two or three times to get a peripheral IV elsewhere. It can be more difficult, but there are nurses who are very skilled at getting peripherals without relying on the scalp. We use the scalp only on kids with bad veins.
My question is at what age can you use the scalp vein till.
I work in a NICU in a teaching hospital, so we have only infants in our unit. However, I have started a scalp IV in one of our "chronic" babies, who was 7 months old. It was a last resort on her,because she needed fluids and antibiotics, until our NNPs could get in a PICC line.
I don't know if there is a set age where you would not start a scalp IV. I think it would be appropriate in infants only, and not anyone over the age of about 7-8 months. There are so many factors to consider when making a choice in starting a PIV. How active is the child? Is he going to reach up and pull it out? When he sleeps, can he turn his head from side-to-side? Is he able to pull himself up in his crib, or roll over completely? These would make me think that starting a scalp IV would not be a good choice in this baby, unless it were a medical emergency, and he needed IV fluids NOW.
In our NICU, if a baby will need long term parenteral fluids, our NNPs or Neos. will get a PICC line in this baby ASAP, to avoid all the multiple sticks, and risks, associated with a PIV.
We had a baby who got his last scalp IV when we was almost 9 months old. Absolutely nothing in his periphery. We don't really use them all that much though, being PICU and not NICU. I've actually never put one in myself and haven't been there when others put them in.
Now, silly question, I know ... but where do you start and what direction do you go?
dawngloves, BSN, RN
2,399 Posts
My guess it's more a cosmetic concern.