Pediatrics Question

[Lily C.]

Where I work, I am not always working with kids. When I do, I have a lot of trouble focusing on the task at hand. Recently, I have not been able to insert a single one of the children's IVs. Usually I get nervous and flustered with the crying/screaming/antics and I just can't concentrate on what I am trying to do. Any advice?

[NotReady4PrimeTime, RN]

-To me, a screaming child is a breathing child so it does not bother me at all. (At least that is how I rationalize it.)

:yeahthat: AND a heart rate (sinus tach!!) and a blood pressure (hypertense!!).

[care4kids]

I am working on an evidence based practice project that might help you out. I am finding research that supports the practice of having a parent hold the child in their lap. You still need to stabilize the extremity on a bed. There is also evidence in the research about things you can use to make the IV start almost painless with things such as buffered lidocaine SQ or LMX4. If you numb the site and it doesn't hurt, the child may be calmer. Also using Child Life therapists to distract the child may help diffuse the situation. Some children will cry just because they are being held down. Telling the child about what they will sense shortly before in developmentally appropriate wording can help increase their sense of control. Taking deep breaths and calming yourself first and being prepared helps you and your patient.

[MachoNurse, BSN, RN]

This forum is awesome! I've watched a number of IV starts on kids, but as a nursing student, still haven't had the opportunity to try one. At the Children's Hospital where I volunteered, there were a few nurses who would usually be called in because they just had "the touch." Other nurses were good at other things. Cest la vie.

[truern]

Not a peds nurse, but did my peds rotation at a major pediatric hospital. We used a treatment room for ALL "owies" and parents were never expected to hold the child.

I can't imagine starting an IV on a wee one...some adults are difficult enough and at least they usually understand "why" they need one.

[JadedCPN, BSN, RN]

Peds nurse here, here's my 2 cents on it all.

While some think holding in the lap decreases anxiety, I don't feel it's the best position for the actual stick. Supine is the best, safest most secure way to make sure nothing moves anymore than it has to be.

Kid veins are easy to go through, so once you get blood back just advance the needle the tiniest amount and then advance the catheter.

Depending on the age, I give the kids a "job," which is to hold as still as they possibly can. I tell them they can scream, yell, call me names, do whatever they want, just not move. I explain to them that if they move, there is a good chance that we will have to do the stick all over again.

Always bring back up. A parent is not the best holder, nor should they feel like they have to be. Even if it takes 5 people to hold a kid down, hold them down so that nothing moves that shouldn't be moving.

Just like anything else, practice makes perfect. Even if you aren't the one getting the IV, try to take each opportunity as a learning experience. Ask the more experienced nurses for tips and suggestions, or just to watch them do a stick and try to pick up on their technique.