IV Sticks in a pediatric pt

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Specializes in LTC Rehab Med/Surg.

I'm not a pediatric nurse, but I work in a rural hospital where all age groups and illnesses are thrown together on the same floor. In 15 years I've never started an IV on a pediatric pt. ER does it, day shift does it,..... I've just always managed to avoid the situation. The other night an IV infiltrated on an 11 month old. I KNEW I could not successfully start that IV. That's not psyching myself out, it is simply a statement of fact. I would have unnecessarily stuck that baby just for the sake of saying that I tried. After several hours, the IV did get started, after 6 attempt by staff...none of us are pediatric nurses. ER has experience, and there are some nurses on the floor who are better at it than others. The supervisor was angry that I didn't "try" Do those of you who are pediatric nurses feel it's appropriate to practice IV sticks on babies? As a parent, I would be outraged if an inexperienced med/surg nurse was poking needles in my child.

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Well, I am an inexperienced new grad working in the NICU, I got off orientation 6 weeks ago and throughout my orientation I did IV sticks, I had to. Technically it was practicing, sometimes I got them and sometimes I didn't but it's how you learn. Now that I am off orientation if my baby needs an IV I will try for it first unless I know the kid is a hard stick, has gone through many IV's and maybe has limited options, in those cases I will immediately survey my surroundings and find the person who is known for being able to "stick a rock" so to say. Now mine is a different situation obviously as NICU is my specialty but I think that working on a unit that takes kids the nurses should at least feel comfortable putting them in, although going through 6 different people trying maybe you could have tried getting an ER nurse up there, because as you said, a parent could get upset after multiple attempts from inexperienced people

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Specializes in LTC Rehab Med/Surg.

I called the ER and they were slammed, couldn't help. Called the supervisor, who could have done it, but refused. To prove a point. I have thought long and hard about my situation and have come to the same conclusion as you. I'm going to have to start IVs on babies. It doesn't matter that it turns my stomach....I have to do it if I work at this hospital. 1) I DO have something to say to parents who admit their babies to hospitals without peds units. YOU'RE IDIOTS. Please, nurses do not say "maybe they don't have any options" There are two hospitals within 25 miles that have peds units. I live in a very rural area. There, one of my pet peeves. Parents who take their precious babies where there are not specialized people to take care of them.

In order to cover my bases about peds admits, I'm talking about direct admits from offices, not ER admits. There are always emergencies and the safe thing to do is take your kid to the closest ER.

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Specializes in pediatrics.

I'm a new nurse on a peds floor. I've only had the opportunity to start an IV once, on a 6 yo. Our babies usually come up with IVs from the ER. But the best part about my floor is that we're all team players. And direct admits from clinics usually get up to our floor, go straight to the treatment room and a couple of us go in and try our best. We have a NICU and PICU to help us too. But I agree about parents taking kids to children hospitals over rural ones... especially if they might need specialty services... I would drive the extra distance for my kid.

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A little secret that Pedi nurses keep is the transilluminator. It's a light that when you hold it beneath the hand/foot, illuminates the veins. If you don't have this light, you can use an otoscope, but it's not quite bright enough unless you have a skinny minnie. This tool at least increases your chances of getting it the first time. When we use it, we prop the treatment room door open and turn out the lights in the room. This illuminates the veins. You should check with your nursing supervisor and see if they might be willing to buy one for you.

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Specializes in LTC Rehab Med/Surg.

I have never heard of what you are describing. :)Just shows you how "rural" we are. I doubt management would provide one for us, as peds pts are mostly seasonal/winter/pneumonia. Thanks for sharing your secret. I just thought all you ped nurses were super duper genius IV stickers.

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Specializes in peds cardiac, peds ER.

Transilluminator is a must, for me, at least. Keep it in your pyxis so no one steals it.

My rule is if I don't see it, I don't stick. Start looking and see what you can find. If you don't see anything, don't stick blindly, but if you see it you may surprise yourself, especially if you are a good stick on adults.

My other rule is, I only stick twice. If I can't get it in 2 sticks, I find someone else.

As far as it turning your stomach to stick a baby, you have to think of why they need the IV, and frame it in your mind as what you are doing FOR them, not TO them.

Those are my thoughts :)

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Specializes in Pediatrics.

I am a peds nurse as well, and I must say I :redbeathe the transilluminator also. I have to say I am pretty good at starting IVs without it, however, when you have kids who are really dehydrated or dark skinned finding a vein is not always easy. When I started working peds, I had never done a kiddo b/c in our pediatric rotation we were not allowed. Instead of shying away because I had never done it, I jumped in whenever there was shot at trying...thats the only way to learn, even though it is considered 'practice' but isnt everything in nursing. Instead of thinking of the pt as a child, just think of them as someone who needs an IV...veins are veins, and sometimes big ppl have little ones and little ones have good plump ones...starting an IV is just the same. Use the knowledge you have in general regarding IVs and you will do great! the greatest difference may only be the size of the needle you use! Just remember...when you started nursing you were inexperienced in general...but you had to be confident in what you were doing anyway and because practice makes perfect...im sure you're an awesome nurse now..U CAN DO IT!

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Specializes in NICU.

I think it's ok to give a try when the opportunity arises. My rule of thumb is not to stick unless I see a good vein that I think I have a decent shot at. But I would still say I miss more than I get, even after 3 years. NICU babies have tiny veins and not always the best circulation! But there's only one way to get better. That said....you shouldn't be in trouble for not trying!

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Specializes in Geriatric, Prenatal, Q.I./Education.

Proactive, ask your supervisor to send you to rotate in ED specifically for Peds IV sticks. Fifteen years is long enough torture worrying about this, now it time to act. It is difficult at first, but it gets better. They are sick and you help them get better. That is why I do this, they come in like rag dolls then leave smiling and skipping out your door!

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I have been a pedi er rn for 2 yrs now (since graduating). When I first started I was afraid of iv sticks. Now I get 90-95% of my sticks. My best a 10 day old very dark skinned pt. Some knowledge that I can pass to you is;

-if you think the are going to move take another rn/ tech with you to hold

- always use a heat pack on your sites ( I always try hands first but also heat pack ac's at the same time)

- take your time. Place band on pt. Look at each hand if nothing Is therenthen look at ac if noyhng there look at the feet

the heat brings the blood to the surface.

-hold their hand firmly in yours. Their fingers shouldbe in your palm and you brace each side of their hand by your thumb and index finger

- get your floor to invest in a "wee sight" $ 90. It illuminates little ones veins so you can mark them or do a stick in the dark.

Heating them up is the easiest and best option

also look at your veins their veins are roughly in the same spot just smaller. I do almost all my I've in the hands and then board their arm if they are really little and use lots of tape

Good luck

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Let me just say that as a mother of a child who has a rare disease...THANK YOU for not trying. I interrogate everyone before he/she sticks my child. We had a bad experience once and that was enough.

My DH was just in the hospital with a bunch of new nursing graduates. The rule is try twice and then get someone else. I was just about ready to scream at the insane number of mis-sticks.

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