IV Starts

  1. 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?
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    About Mofe'ny

    Joined: Oct '01; Posts: 76; Likes: 11
    Level II Neonatal Nurse


  3. by   prmenrs
    Our unit has a policy for everyone--RN, NNP, MD--3 tries per customer, that's it.

    Use any vein--saphenous, antecub, scalp. Not usually jugulars or stuff they need for major surgery.

    After as many attempts as you are describing (actually quite a few less), I'd have called it quits, given that particular dose(s) IM, made SURE the kid got plenty of PO fluids, and tried again for the next dose. Sometimes the baby is dehydrated, and you can't get a good enough flow to thread--did you try "flushing" it in? Probably you did.

    Transilluminators help some people, not me.

    I'm older, and I need bifocals, but they aren't strong enough for IV's and urinary catheters. I bought a $10 pair of drugstore reading glasses, put them on (on top of my regular glasses) to help with those tasks. All of a sudden, all the older crowd in the nursery keeps "borrowing" my magic IV starting glasses!!! Looks VERY dorky, but works great. So, if you're in that age group, you might want to give it a try.
  4. by   Jolie

    Does your unit use PICC lines? It sounds like this baby could use one!
  5. by   danielle2000
    When I start IVs on babies I try for the biggest vein in the lower leg. You can't visualize unless you use the transilluminator. It is a very big vein that will last for a while. I only do scalp veins as a lost resort. I know how you feel. I try 3 times and ask our transport nurse. Term babies are more difficult because tthey are more plumper than our preemies
  6. by   Teshiee
    It has been our policy to stick 2 times and that is it. I know there is always someone in the unit who is very good in IV starts on neonates. One veteren nurse told me that there was always a large vein in their leg you need to a transilluminator to find it. So far I have had luck finding it. The last resort is a scalp vein. I don't know why there isn't a standard protocol to just have a PICC line inserted for ABT therapy.
  7. by   travelingtweety
    I'm not sure why so many use scalp veins as a last resort. They are comfortable for baby, as they don't require a board. Baby gets to kick his feet and suck on his fingers. Yes some parents do freak out but we've made an educational bulletin board. Some parents actually tell us they'd prefer a scalp IV, that it makes holding baby easier. I do use a transilluminator at times. If the baby has the veins that blow everytime you advance the catheter I use the light to watch the catheter actually enter the vein. That way I don't go thru the vein while waiting to get a flash.
  8. by   magRN
    Three trys and that's it per person, and only transport nurses or transport RT's do this.
  9. by   NicuGal
    Sometimes it isn't skill...it is luck! Some kids are notoriously horrible sticks! We love scalp veins...and if a kid has a reputation as a bad stick...I go there first. I know parents wig out about it, but it is better than sticking the kid a hundred times!!! And don't forget the big ones in the back of the scalp!
  10. by   jrmcdoug2
    I'm a term newborn nursery nurse and sometimes we do IV's on babies that may need anitbiotics or D10W for a few days. I'll tell you what....the sicker they are the worst their veins seem to be. The term babies have plumpier veins....you might not be able to actually see the vein but you can sure feel it. I also use the transluminator if need be. The veins in the hand seem to be the easiest ones to me.I think removing the needle after you get some blood return and guiding the catheter in is somtimes necessary. Somedays it's pure luck though. I know you guys must be thinking......"what does this well-baby nurse know about starting IV's on babies". The funny thing is, we should not have to do those things on so-called well-babies in the first place.

    Hey can I ask you guys a question? Do you guys get a kick out of doing septic W/U and starting IV's? I love it.....that sounds bad doesn't it?
  11. by   NicuGal
    I used to love doing septic w/u's until the hospital decided we can't do art sticks anymore... to them! But I love to start IV's....I can usually get most kids on the first stick, but sometimes I get in that rut! My fav veins are saphenous, wrist and front scalp!
  12. by   jrmcdoug2
    I just love doing art. sticks!
  13. by   NicuGal
    I love them too~LOL.....some of the attendings will let us do it under the table...not smart, but I love to know I can still hit it on the first stick! They are trying to get them to turn it around again so we can....we used to put in art lines too...and that was easier on the kid than letting the resident poke and prod away
  14. by   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.