neonatal IV sticks

Mimi2RN, ASN, RN · Feb 8, 2004

On premies I usually start with the saphenous veins. They are usually a good size, and straight. We use Introcan 24g catheters, which have a safety needle that is covered as it's withdrawn. I prefer to flush the catheter with saline before I start, as I see the flashback quicker. If I have have a problem advancing, I'll withdraw the needle, add the connecting loop and syringe, and try to float it in. It's usually easier finding veins on a premie, than on a chubby 9lb plus baby. At least you can see them. On the bigger ones you sometimes have to go by feel only. Hands and feet are first choices, scalp veins are usually tried last. Parents don't like them, but it's sometimes a better choice for a breast feeding mom.

Of course, the taping is important. A sloppy tape job can mean your IV won't last long.

BittyBabyGrower, MSN, RN · Feb 10, 2004

We have safety caths too, but we have the option of not retracting the needle until we are done. I like the saphs first too :) I do like scalps too...they seem to last longer. Freak out parents, but they do last longer.

And I agree with the taping...that is sooo important!

Brownbetty · Feb 21, 2004

I like to start my IVs in the hands or feet first. I try to leave the upper arms and antecubs alone for future placement of PICC lines. On the micropreemies I do the same but it is much easier to go for the saphenous on those little ones since they are big and easy to see.

After I get the flashback when starting an iv I like to take my needle out (saftey needle of course) and (as someone else mentioned) float the catheter the rest of the way in. If I have an extra hand, I will have someone slowly flush while i guide the rest of the catheter in. I learned this from more experienced nurses. Usually when people try to advance the catheter while the needle is still in their veins blow because the needle is shredding the vessel.

Oh Yeah I like hands and feet especially on bigger babies because I can bundle the baby in blankets and leave the extremity exposed. THsi helps to better control the baby since the bigger ones fight kick and scream :uhoh3:

At my institution you are supposed to try 2 or 3 times then ask someone else to try. However that is not always possible and you have to try until you get it. Having to wait an hour for someone to be able to help you get an IV canbe a pain when you pt is NPO and you have to cut their fluids off since you don't have an IV and all your IV meds/atbx are due right when you IV went bad. :angryfire

I like to use our little rubberband tourniquets Unfortunately, I must admit, I have started to favor using a transilluminator when I start my IVs. :uhoh21: However I was trained to get IVs without the use of the transilluminator.

Hope my babbling helps :balloons: :rotfl:

vemiliob · Feb 22, 2004

Hi,

Im just jumping on neonatology as my ultimate skill after eight years of alternating peds/adults.

One picture is better than thousand words. Why dont you take a while observing other nurses? specially the skilled of your institution. I asked the chief of Peds for permission and then talked to a Coworker proposing to assist her for a while. In my institution most peds are just babies from one to nine months, we do the IV's but often have to perform the labs technician work, because they are afraid of touching babies. That means taking arterial blood as well. Sometimes we need four people (including the child's mother) to keep a four-month-twisting-kicker quiet enough to do our job.

Really I preferred neonates, you can handle them mostly alone and never need the assistance of more than one person. We never use the scalp, mostly hands and feet. We are allowed to take arterial blood only from the radial artery(of course when the umbilicus is any more available). I hate this artery! Just a tiny hair.

But I insist, it's been really helpful for me to assist the best nurses of my institution (some are really monsters of neonatology). I'm sure you'll find a good model to learn from. We never stop learning. In the moment we do we better retire. :rotfl:

dawngloves, BSN, RN · Feb 23, 2004

Really I preferred neonates, you can handle them mostly alone and never need the assistance of more than one person.

:rotfl:

Every try an put a line in a pissed off 10 pound neonate? I'll take a little old lady on a Heparin gtt any day! :chuckle

I'd like to re iterate that you should try and learn to start them without a transluminator. It is to your benefit. Imagine trying to hold the 10 pound baby, the transluminator and start the IV. I use it as a last resort on the fat kids and kids that have had multiple lines, but I know people that that's the first thing they run for and you can visualize a vein without it. :uhoh3:

Brownbetty · Feb 24, 2004

:rotfl:
Every try an put a line in a pissed off 10 pound neonate? I'll take a little old lady on a Heparin gtt any day! :chuckle
I'd like to re iterate that you should try and learn to start them without a transluminator. It is to your benefit. Imagine trying to hold the 10 pound baby, the transluminator and start the IV. I use it as a last resort on the fat kids and kids that have had multiple lines, but I know people that that's the first thing they run for and you can visualize a vein without it.

I have actually gotten an IV in one of those big babies fighting away and holding the transilluminator ( don't recommend it but it can be done). You work your darnedest to get your iv and you need it desperately and no one is available to help.

Jolie, BSN · Feb 24, 2004

On smaller babies, I try to start the IV without a rubberband tourniquet, as using one seems to make the veins more likely to blow. I just use a finger to apply gentle pressure above the site I'm sticking, or ask a helper to do that for me. Ditto saving the transilluminator for a last resort. On transport, we never had one when we needed it, and a penlight is a sorry substitute!

Mimi2RN, ASN, RN · Feb 24, 2004

Any of you use Introcan 24 ga catheters? We have recently been having real problems with blown veins, and think it's this batch of catheters. We had a few older ones,(the labels are different), and were much more successful with those.

Pedi-ER-RN, RN · Feb 3, 2006

Have had the same problem with Introcan 24 and 22 ga. I really think there was a BAD batch! :angryfire :angryfire

Also, has anyone had problems with the needle not wanting to come out of the hub after it blunts off?? I had this problem a week or so ago and had to "tug" pretty hard to get it out. Just wondering if anyone has experienced the same?

Mimi2RN, ASN, RN · Feb 3, 2006

Have had the same problem with Introcan 24 and 22 ga. I really think there was a BAD batch! :angryfire :angryfire
Also, has anyone had problems with the needle not wanting to come out of the hub after it blunts off?? I had this problem a week or so ago and had to "tug" pretty hard to get it out. Just wondering if anyone has experienced the same?

Sometimes it can be tight, but for safety needles, it's not a bad system. As long as I have help with someone holding the baby, it's OK. It can be hard pulling that out, then screwing on our wonderful connecting tubing, without blood backing up. We used to have connectors that just snugged in, and tightened with a little twist. Now we have the new "improved" version, that can be a real pain to connect and screw down tight. Of course, to the person that rarely uses them, that ordered the new equipment, they are much better......

vemiliob · Feb 5, 2006

I'm not doing nicu since 2005, 11th months ago, but ER instead. Anyway I've to assist neonates, not so often as before but still on it.

We do not have a transilluminator. Only big Hospitals do. And I use a 24´s for IV's and a 15/5 (don't know how you call it?) with a 1 ml syringe for radial artery. My co's of the nicu use a 25's butterfly working by pair.

I'm always alone! And always ask moms for help, sometimes fathers as well, but not all of them support the situation.

It works much better. I can teach them while performing my job. On such situations they are much more receptive.

Probably it sounds useless if you work at big Hospital, but if you belong to a small rural area it can be of some help.

Kisses and hugs from Buenos Aires.

Emilio:rotfl: