neonatal IV sticks

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Hi,

I know sometime this thread has been done before, but I can not find it.

I was hoping you would all take the time to do it again.

I want all your IV stick tricks of the trades kind of thing.

Where do you like to start an IV and why?

What are your tips for difficult sticks. How many times do you try, needle type preferences etc. tourniquet or not?

Big neonates, micropremies any and all tips appreciated.

Thanks so much

Specializes in Babies, peds, pain management.

In my unit, I'm known for being able to do the 8-12 pounders (newborns) and the 3-4 pounders make me nervous. It takes all kinds! But what I would like is tips on taping. It is very important but everyone I work withhere just seems to add tape over tape over tape. Makes it impossible to view the site and really tears up the baby's skin. Any gems of wisdom to share?

asher315

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Specializes in NICU.

We use VeniGuards, they don't tear up the skin. Other hospital use Tegaderm or Opsite, but the area over the catheter insertion site should NEVER be covered with anything else. We still have nurses that totally cover the site with tape, so you cannot tell when it's starting to go bad.

I use one strip of 1" tape backed by a folded 2X2 above the site, that is attached to the armboard. The fingers or toes are taped with a narrow strip, then taped to the board. I frequently cross the hub with two narrow strips in an "X". Usually I have folded 2X2's under the tubing by the hub, that reduces the pressure on the hand. I try to use narrow strips of tape, sometimes between the catheter and the wide strip, or across the hub.

If you tape carefully, you will be able to see the site and still won't rip the skin off the baby when the catheter is removed.

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Specializes in NICN.

I realize this may be a bad question to ask on this site but I was wondering how soon after you first start work in a NICU do you start IVs? Do you take a class first or what? This scares the heck out of me!!!

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Specializes in NICU.
I realize this may be a bad question to ask on this site but I was wondering how soon after you first start work in a NICU do you start IVs? Do you take a class first or what? This scares the heck out of me!!!

It really varies by unit. Some places start you during orientation, others make you wait until you've worked in the NICU for six months or so. Big variation, I think.

We didn't have to take a NICU specific class. During the initial hospital orientation when I first started, there was a class on IVs one day, to get to know the specific catheters and tubing used by our hospital. We practiced on rubber arms, talked about lab draws, etc. The second day of the class they practiced on each other - but I was exempt from having to come that day since I was going into the NICU and "they'd train you there" I was told.

On the unit, we had to do a written test after learning about IVs and lab draws in neonates. After that, we had to try three capillary sticks, three arterial punctures, and three IVs with an experienced nurse watching us. Once we got the technique down, they signed us off on it and we could then do it on our own. When I started seven years ago, I was able to do the capillary sticks during orientation, but the IVs and art sticks had to wait until I'd been on my own a few months. Nowadays, they let the new nurses do everything during orientation. So it even varies by unit.

I have to say, IVs and arterial sticks are two of my favorite procedures because they give you such a sense of accomplishment when you get them. And I was terrified to even give IM shots during nursing school, so don't worry, you'll not always be so scared.

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Specializes in ER, PED'S, NICU, CLINICAL M., ONCO..

OK Kalico,

Probably you might not be interested in a far foreigner nurse-opinion, but because I belong to a less structured health system than yours, it could let you enrich your mind with far foreigner experiences as well as yours, of course.

When I was finishing my 3rd nursing (RN) I asked for permission for staying my complete practicing in the nicu. People in that NICU (Mar del Plata/Bs.As./ Argentinean Hospital, "HIEMI"), noticed my natural affinity with neonates and they make me do everything, including IV's with premature and sick newborns.

Our HPC MdP Hospital was visited for a Nurse Doctor and a BSN, belonging to a Californian Nursing Board. We were close to make an exchange with a Californian University Nursing School, but finally nothing happened.

In my 13th years of nursing I've met hundred of nurses of different ages and levels of preparation. Believe me! Not everything is for every one. I'd said it is hard to start with the NICU or the ICU without previous experience in lower levels. Someone else could say "just do it"!

We are not the same. We are not all equal. You might like babies and not have hand mastery or ability. You might be a peace of ice genius, and you might be a normal nurse as well.

To be honest and objective, I'd said "there is not a recipe". Your may find it by your self, and it will take time...

I believe strongly that there is an internal conviction about our powers. If you feel that, don't hear anyone... Just do it! Continue, because jalousie and competition will always stand against you on your way. If you feel that you are not able, just run away! , because you're not handling things but babies...

Experience a dead pt baby on your hands and responsibility. Experience her or his parents grieve after her/his dead. And afterwards you will understand what you are working with.

There is more than IV's, more...

Did you get it?

It is not only the question of IV's what matters. There is much more.

Got it?

Have a kiss!

Emilio.

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In my unit, I'm known for being able to do the 8-12 pounders (newborns) and the 3-4 pounders make me nervous. It takes all kinds! But what I would like is tips on taping. It is very important but everyone I work withhere just seems to add tape over tape over tape. Makes it impossible to view the site and really tears up the baby's skin. Any gems of wisdom to share?

asher315

We generally put a piece of silk tape across the hub close to the insertion site. Our catheters have wings, so we then chevron tape down over the wing with another piece of silk tape, imagine it forming a "U" shape. (If your catheter is wingless, you could do the "classic" chevron taping where each end crosses the hub.) Then the whole site is covered with a tegaderm, and the t-connector tubing is looped and taped down over the top of the tegaderm for extra security. This keeps the iv in securely for most babies and the site remains visible. The silk tape is my favorite - holds better than the paper tape, but doesn't tear up the skin like the "plastic" tape.

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Specializes in NICU-Level III.

New nurses in the NICU I work in are expected to begin starting IVs immediately; it's better to get over that fear and start gaining confidence and skill immediately. We have semiprivate rooms with two babies per pod; each pod has a transilluminator which we are encouraged to use. They are also in the transport bags. They can greatly increase the likelihood of a successful stick, and we don't want to stick our neonates any more than absolutely necessary. We have gotten transports that the nurses at the other hospital stuck everywhere and our transport nurse uses a transilluminator and gets it on her first stick!! We don't stick saphenous or antecubitals so they are available for PICCs. Our cathlons are winged, so I usually use a narrow piece of tape, sticky side up, underneath the wing, then fold the ends over the wings on either side of the insertion site. It ends up looking like an inverted U. I cover the site with a transparent dressing, put a little cotton under the hub as cushioning to protect the skin, and put a piece of tape across the hub. We use armboards for IVs in the arm or foot. In taping the extremity to the armboard, we never tape over fingers or toes. An IV can be taped and preserved without restricting their range of motion. I also use a little bit of cotton on the tape used to secure the armboard so that as little tape as possible is directly stuck to the skin. Lastly, I anchor the extension tubing to the armboard (or the baby's head, if the IV is inserted there). Hope this makes sense!!! It's easier to demonstrate than narrate:-)

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Specializes in NICU, Post-partum.

I've been in the NICU since graduation in May and I have yet to start an IV successfully.

I could do it all day long on adults, but for some reasons, I can't get these little ones.

I would be tickeled to death, at this point, to get anything, even if it blows...I'm missing it entirely.

If anyone has ANY advice...I am all ears.

I have so far, got over the fear of "hurting" the infant....but I feel my job is to get it the first time.

We don't stick arterials in my unit (level III)....the NNP's stick those with a transilluminator, but no one in our unit uses it for regular IV sticks.

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Specializes in Retired NICU.

i wish we still had silk tape, it is my favorite also, works beautifully. we are stuck with the plastic tape, and it doesn't even tear well, it doesn't mold and stick like the silk does. i also like to do the chevron taping and then use a piece of tape over the hub to secure to the arm, hand, wherever it is. cover insertion site with a transparent dressing, then make sure that t-connector tubing is taped securely: i like to put a piece of tape over the t-connector tubing and pinch both sides of the tape coming down from the tubing to secure the tubing, then secure the rest of the tubing to the armboard, that snugs it up a bit so it doesn't get loose and slip.

we generally put a piece of silk tape across the hub close to the insertion site. our catheters have wings, so we then chevron tape down over the wing with another piece of silk tape, imagine it forming a "u" shape. (if your catheter is wingless, you could do the "classic" chevron taping where each end crosses the hub.) then the whole site is covered with a tegaderm, and the t-connector tubing is looped and taped down over the top of the tegaderm for extra security. this keeps the iv in securely for most babies and the site remains visible. the silk tape is my favorite - holds better than the paper tape, but doesn't tear up the skin like the "plastic" tape.
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Specializes in MSN, FNP-BC.

As far as tourniquets go, I only use them when I am hunting for a good vein. I have found that if I leave it on while doing the IV, I have a tendency, as does my partner (I never do them alone...at least not yet) and I will blow it when I go to flush every time.

Sometimes I don't even need one when I go hunting but that is more the exception than the rule on the bigger kids.

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Specializes in Foot Care.

I transferred to a Level II nursery last summer, after working for over 12 years on Mother-Baby. It's taken lots of attempts over several months, but finally was able to do a successful IV blood draw the other day. I assist and observe whenever I get the chance with skilled co-workers - on some of our premies even they aren't able to get a decent specimen, so I don't take it personally when I've had unsuccessful attempts. My main issue is that I know my skill level is novice, and I feel like I'm torturing the baby if I can't get it on my first attempt, especially if I already know that they are a "difficult poke".

I've never seen anyone use the transilluminator for venous access, I may have to try that while I'm working on my skill level. Thanks for that suggestion!

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I have been in NICU since 1991. Took me a long time to get good at IVs, but most days I can get ones no one else can! Some days nothing works.

Favorite sites: feet and ankles! The veins are bigger and easier to access, but you do have to tape them in such a way that they can't kick them out. Positioning the baby is also important. Be careful not to stick the one on the top of the foot in a way that requires you to extend the foot and keep it that way for the duration of the IV--that is painful for the baby. I also like the one that runs along the backside of the forearm. Remember to always start furthest out--once you blow high, you lose all the sites below for at least a few days.

I prefer the micropremies--I hate sticking big, fat babies! Again, the trick there is the ankle.

Worst babies to stick-jaundiced and dehydrated. They blow easily--and sometimes nothing is going to work and they need a central line.

Trick for a hard baby to stick: for whatever reason, using a slightly chilled heparin flush to flush with when you start the IV can make it less likely to blow.

Trick to babies: stick slow, wait for blood return. Jaundiced and dehydrated babies often don't bleed back. If you think you are in, gently flush. Once you have return, advance the needle just slightly to get the plastic catheter into the vein instead of just the tip of the needle, then advance the catheter with the needle still in place. Remember, it is a tiny vein--it is a very slight advancement!

We don't use transilluminators for veins, but they do use them for radial arteries. I'm not that co-ordinated.

I usually stick alone. Wrap the baby securely, leaving the extremity you plan to use out. Remember pacifiers and sucrose--it's proven pain relief and calming for the baby. However, if you have a real fighter, get help--better to have someone hold the arm or leg (or entire baby) than to have it kicked out before you can secure it. I have had a 1 pounder that I needed help with and a 10 pounder I could stick alone!

We have a strict 2-stick limit per nurse. Get help if you can't get it!

New nurse or new to NICU--practice! Offer to stick every IV that comes available! Stick once, pick the fattest vein, and have help. Once you get it, you'll get it! Good luck! (and sorry this was so long :)

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