My Kid is a Tough (tough) Stick... Help

  1. In my 2+ years of ED nursing, I've started a bunch of lines... probably 1,300 or so and I'm now facing a situation which I'm not sure how to approach.

    My kid has had a variety of health issues and been stuck lots and lots of times beginning with her day of birth as a 27-week preemie. About three years ago, a pediatric anesthesiologist took 3 tries to get a line and a couple days ago, now at age 11, an oral surgeon punted after 3 failed attempts.

    Unfortunately, there's no ultrasound nor even a venoscope...

    Any suggestions how to best prepare for a successful start?

    I'm thinking something along the lines of spending the day pushing PO fluids, going for a run, and then hopping into a warm shower... maybe even some PO valium to help her calm down and reduce sympathetic peripheral vasoconstriction (she'll already be prepped with EMLA).

    Any other ideas how to plumpen those little spaghetti veins of hers?
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  3. by   hiddencatRN
    Does she require IVs a lot? If she does, it might be worth considering an implanted port for access. Does she usually get EMLA? That can cause vasoconstriction, making the process that much trickier.
  4. by   classicdame
    most people, including CRNA's, are used to sticking adults. Ask for a nursery or pedi nurse if possible. I used to go from Pedi to ED a lot to stick kids.
  5. by   AgentBeast
    Get an experienced Neonatal ICU nurse to do it. I'm convinced those nurses could start an IV on a fly if they had to.
  6. by   ♪♫ in my ♥
    When she was an infant and went to the ED, they finally had to call a NICU nurse to come start a line. I'm talking to her MD to see if we can figure out a way to get a PICU/NICU nurse to do a line.

    The system is so compartmentalized that it makes it needlessly hard.
  7. by   nurseprnRN
    Portacath. If she's going to need IV access that often, it will be a lot easier for her and her caregivers.
  8. by   JustBeachyNurse
    I'm sorry for the medical issues of your child but as per the site terms of service,

    "Medical Advice: ALLNURSES.COM, INC or it's members do not offer medical advice. Any requests for such will be taken down. If you have a medical problem, please seek attention from your health care provider. You are not allowed to ask for medical advice related to a health situation that affects you, a family member, or someone you know."

    You have received some good responses in this thread and I hope you find a solution that works for your little girl.