IV Starts

[Mofe'ny]

Help! How many times do you all try to start an IV on a baby? I get so frustrated sometimes. We will normallly try a total of 4 - 6 times(different staff RN's) before calling the NP's. I was ready to cry this morning when I left work, because after we had attempted 5 sticks, I called the NP. She came in to start the IV and I lost count of how many times she tried. I had to give report and the day shift nurse started helping her. Does anyone have any tips on starting IV's? WE could get flashback, but the catheter would not advance, the vein would blow. This is a term baby with pneumonia, so I am sure she will be on at least 10 day's of antibiotics and she is only 3 days old!

Also, do you use saphenous or Antecubitals? Do you use transilluminators when you start IV's?

[AquinasNurse]

I work in the well baby nursery and float to NICU. Usually, 3 tries and I'm done. If I can't get the first two, I'm going for the front of the scalp. I know the "little horn" sticking up isn't the prettiest sight, but they are much easier on the babies. They can suck their fingers (and not on the heplock) and be held so much easier.

[MEtheBabiesRN]

Two sticks is the max for anywhere I've worked. My favourite is the saphenous vein. Least favourite baby to start an IV on is the big term babies. Can't see a thing.

[Darlene K.]

Two sticks is our limit.

[cindyln]

I will try 2 times and then call anesthesia. I have never seen one of our docs attempt much less put in an IV but anesthesia will give it a try. I love scalp veins.

[Mimi2RN, ASN, RN]

We do two sticks and then someone else tries. Sometimes everything blows on a term baby, but the little skinny vein on top of the foot will be a good IV, even if it doesn't look big enough to hold a catheter at first. I will also go for a scalp vein, I think they work well, even in breast feeding babies. I've never looked at the back of the head, though........The vein that I don't use is on the inside of the wrist. I think that hurts the babies most, it certainly would hurt me!

[LilgirlRN, ADN, RN]

I work in the ER and we usually don't have to start IV's on babies that small...I recall reading somewhere about trying a thin film of NTG paste over the site on newborns although I've never tried it myself. Has anyone?

[KRVRN, BSN, RN]

We try 2 sticks each until we've come to what we all agree is the best IV starter on the unit at the time (usually a veteran RN or NNP--never an MD) and then that person will try over and over until we get something. If it seems like it's going to be a hard baby we go to the best person either right away or after maybe 1 other person tries. How funny... scalp veins are ALWAYS our last resort. I like the hands the best and just about always go for those first. I also like to use the transilluminator, sometimes after a visible hand vein blows I can find the same vein a centimeter or 2 up and then hit it.

We have never tried NTG paste. I'm sure it would work but I can see even a small amount on a preemie messing up the BP. Then again tiny preemies are a lot easier to start IV's on than big babies.

[NICU_Nurse, BSN, RN]

Speaking of transilluminators, what type do you use and/or prefer? We don't have these on the unit, but I noticed in the journal I got a few months ago an ad for a cool-touch transilluminator for around 150$...was thinking of getting it for my own use but have no experience with them. Any thoughts? ;>)

[travelingtweety]

Don't spend that kind of money on a transilluminator. A penlight will usually work just as well for IV starts. Just make sure it doesn't get too warm. I have a tiny light I take with me on air transports, works great. I think it came from a camping/hiking supply store. Make sure it's the kind that stays on without having to hold a button down.

Laura:cool:

[NICU_Nurse, BSN, RN]

Laura, that's a GREAT idea!! I'm going to try that at work tomorrow. Isn't it funny how those simple ideas just never occur to you sometimes? Thanks for the tip. ;>P

Kristi

[NiteNICUNurse, BSN, RN]

Transilluminators usally don't work as well for term babies. Iv'e found that putting heel warmers on the area for a while seems to help. Our policy is 3 sticks and then fentanyl SQ before trying again. Of course this can be a problem with non vent babies! I usually go for the deep veins in the leg and near the knee. But a lot of my co workers like the small vein by the thumb, even though its small it seems to last. Also not using a tourniquet for an infant whose veins tend to "blow" seems to work.

[kmaryniak]

It's always been my practice to a limit of 2 attempts per nurse. I love scalp veins, personally. I know parents don't like the look of them, but they work great, and tend to last. I've noticed at my recent hospital that some nurses take as many attempts as they want (even 4 or 5). The worst is, I've seen some nurses re-use the same needle/cannula, after flushing it with saline. I think that is the worst! I prefer not to use an elastic for a tourniquet, because sometimes it does more damage than good.