IV Starts

Good luck in your new job! I'm a big fan of hands and feet in the little ones. Warming the area first is helpful, sometimes I'll use a small diaper with warm water in it and put around the foot to help plump thjngs up. If the baby is little, I cut the tourniquet in half (making it skinny) or use a thicker rubber band that I cut so it isn't a circle anymore.

I don't mind either way if parents are there, but I never ask them to hold the child down in any way. I let the parents comfort the child throughout. Sometimes it helps calm the baby if mom nurses while the IV is being inserted.

Why cut the tourniquet? I've seen nurses do this but I don't see why it helps. I tried it once but it just made my tourniquet fragile and it snapped in two when pulled taught.

Do you have a treatment room to take the baby too? Usually we take the kids out of their room for painful procedures and we give parents the option to come in the room, usually when they are an infant or toddler parents will come in the room. We usually have parents hold the child if the feel that they can as that is more comforting to the child. There is extra staff in the room to help inmoblize the extrimitey in which we are putting the IV.

Only one person does the talking as to not overwhelm the child.

Use distractions...books, TV, iPads,...coworker dancing...anything to get them to look away.

Warm the area

I have never seen the cut tourniquet

I also have cut the tourniquet. It is all personal preference. Most people assume that children are more difficult IV starts than adults but I have found that children are actually "easier" because their tissue/veins are not as scarred. I use "easier" in quotes because it depends on the situation and the child. If you have child life therapy, consult them! they are excellent at distraction and have different techniques even for the younger ones...usually the old fashioned "hold them down and do it" is not the only way. This only exacerbates fear and fighting. Parents can be helpful but it depends on the situation as well. Sometimes their stress makes the situation worse but a calm, collected parent can make the difference.

As far as technique...in time you will figure it out. but the tips above are good. One other tip I would give is something that an IV therapist showed me. If the kid is screaming and throwing a fit during the access attempt and you think you get access but you are not getting blood... just let it sit there for 30 seconds or so... a lot of the time the vein is in spasm...it will relax and let you advance after about 30 seconds.

Hope this helps.

Why cut the tourniquet? I've seen nurses do this but I don't see why it helps. I tried it once but it just made my tourniquet fragile and it snapped in two when pulled taught.

it does make some tourniquets more fragile but it allows you to get the tourniquet tighter around smaller arms because you do not have so much excess but this is just personal preference...there is no real reason that makes this a better technique

The very few peds IVs I've started, I've noticed that their veins, while smaller, have a very definite feel for when you're in. There's an almost palpable "pop" upon entry to the vein. Their veins aren't scarred up, full of plaque, and in general, are nearly perfect. You do have to have very good technique and be able to palpate exactly where their veins are. I haven't started a line on a kid in a very long time though, so I'm nowhere as good as I was.