Iv Cannulation Insertion Tips And Documentation

SteveNNP, MSN, NP · May 30, 2008

Is there any specific tips in insertion of cannula's in neonates? How many pricks can be done at a time? what is the recommendation. How can I perfectly document after insertion/ Iam not that good in naming veins anatomically? Ihave to do a presentation on this .Dear friends, Do you Know any free downloadable websites.I need some pictures also. Which brand of cannula's do you feel good?

Run a search on neonatal IV insertion here on AN, since there are a lot of recent threads on that subject.

As far as # of sticks, the last unit I worked in, each nurse could try twice, with total number of 6 before calling the MD for an order to continue sticking. I liked that policy, as it forced someone to look twice as hard for sites before sticking, and honestly, if you can't get it after 2, you need to step away and let someone else try.

Equipment: We use BD's Insyte Autoguard. I prefer the BD ProtectIV catheter I used at my last job that manually retracts as opposed to the push-button one. I also miss the 26ga Hospira angiocaths I also used to use. They were great for small babies and small veins. You could run whatever you needed to through those.

When starting an IV, this is what I document:

"24ga PIV started x 1 attempt in LFA. Site flushed and secure with tegaderm/tape. Site clear/benign without redness or edema. Infant tolerated procedure without difficulty."

Check out some IV therapy or even BD's website for vein diagrams.

Hope this helps!

Preemienurse23 · Jun 4, 2008

I have seen our transport nurses and our NNP's try multiple times for an IV. We don't have a set policy that I am aware of, but I usually don't try more than 2 times. It just depends on the kid, If they are a hard stick, once is usually my limit just because I'm still new at this.

SarasotaRN2b · Jun 4, 2008

Considering the size of the preemies and their respective arteries, do you use any of those UV vein finders (sorry don't know the correct name)? I mean, it is tough enough with adults who are difficult sticks but I would think that being able to give a neonate an IV takes almost superman vision.

SteveNNP, MSN, NP · Jun 4, 2008

Considering the size of the preemies and their respective arteries, do you use any of those UV vein finders (sorry don't know the correct name)? I mean, it is tough enough with adults who are difficult sticks but I would think that being able to give a neonate an IV takes almost superman vision.

I don't know of any NICU that uses the UV vein finder. We did have a thread on that a while back, and no one had heard of it. I don't think the resolution was good enough to see the small veins on a neonate. That combined with the caveman tussle of holding a 1.5kg preemie still as he manages to wiggle away with 3 nurses holding him.....probably too much motion for the machine to work.

Some people really like the transilluminators and have good luck with them. I haven't gotten a single successful stick with one, so I rely on my eyes and touch.

RNs here do not perform (intentional) arterial sticks or cannulation.

SteveNNP, MSN, NP · Jun 4, 2008

I have seen our transport nurses and our NNP's try multiple times for an IV. We don't have a set policy that I am aware of, but I usually don't try more than 2 times. It just depends on the kid, If they are a hard stick, once is usually my limit just because I'm still new at this.

It's one thing if you are alone on a transport. If there are other nurses there, that person needs to step back and let someone else try.

You may need to go to your manager about this, as well as getting a policy written. Overzealous people cause more trauma to the baby and have less successful attempts the more and more times they stick the baby.

Sometimes all it takes is you saying "Let's let Lucky LouAnn give it a try after this stick" for someone to get the idea.

When someone calls me to start a difficult IV, it doesn't help matters to have had someone blindly stick the baby 8-10 times in a desperate attempt at IV access. Stick twice, and then let someone else try.

SarasotaRN2b · Jun 4, 2008

Hey SteveRN21,

Where are the areas most used for IVs in neonates?

Kris

SteveNNP, MSN, NP · Jun 4, 2008

Hey SteveRN21,
Where are the areas most used for IVs in neonates?
Kris

Ha! Anywhere you can get one. The most unusual one I saw was a PIV placed in a superficial abdominal vein.....

Most typical are the veins on the back of the hand, basilic and cephalic on the forearm, and antecubital veins. So are the veins in the feet, as well as the saphenous. I LOVE to go for a juicy valve-less scalp vein.

More unusual ones are the popliteal veins, veins on the underside of the wrist, and axillary. We try to avoid all those unless desperate.

preemieRNkate, RN · Jun 5, 2008

Ha! Anywhere you can get one. The most unusual one I saw was a PIV placed in a superficial abdominal vein.....
Most typical are the veins on the back of the hand, basilic and cephalic on the forearm, and antecubital veins. So are the veins in the feet, as well as the saphenous. I LOVE to go for a juicy valve-less scalp vein.
More unusual ones are the popliteal veins, veins on the underside of the wrist, and axillary. We try to avoid all those unless desperate.

A nurse that I used to work with told me that the unit where she had previously worked had placed IVs on the abdomen. I couldn't believe it! We don't do it, but sometimes when I see those juicy looking belly veins, I think of her. She was also the nurse who taught me how to place a scalp IV, which I LOVE!

elizabells, BSN, RN · Jun 5, 2008

We've done it twice in two years that I'm aware of. And once recently we had a poor wee thing with IOs!

I stick no more than twice. Usually once. I'm kind of pathetic at it, so I figure why ruin the veins? On the other hand, I'll never get better if I don't at least try. I think after my first 6 months I went a full YEAR without trying again. A certain friendly boy nurse who you all may know () made me start trying again.

SteveNNP, MSN, NP · Jun 5, 2008

A nurse that I used to work with told me that the unit where she had previously worked had placed IVs on the abdomen. I couldn't believe it! We don't do it, but sometimes when I see those juicy looking belly veins, I think of her. She was also the nurse who taught me how to place a scalp IV, which I LOVE!

Yes, scalps are awesome.... and there's always one good one, even after the kid's been pincushioned. They always thread like a charm, and you can hide them pretty easily. I have a hard time convincing the baby's nurse sometimes. I'm like, do you want me to stick him 10 times, or once??

Last time I checked, one stick hurts less than 10.

The abdominal IVs were on a kid who was in the throes of raging serratia sepsis, and had to have his broviac pulled. He was so edematous, the only veins he had were guess where.... in his scalp (2 IVs) and his abdomen. I did not personally place that one, but I would have been SUPER careful. I freak out a little putting an IV in near the anterior fontanelle.

elizabells, BSN, RN · Jun 5, 2008

It's funny, those blown-up sepsis kids lose all their other veins when they get edematous, but the belly veins get so much easier to see! The other one I've see was on a similar kid. I think the NPs put them in.