Peds IV Tips

Altra, BSN, RN · Jun 24, 2005

Hi Aneroo - like you, I've just started in the ED.

I've done 1 IV start on an 11-year old, and 1 on a 13-yr. old, but not any small kids or babies yet. Not looking forward to it, either ... :rolleyes:

I've observed some starts on little ones though, and I've learned a couple of things:

1) let mom/dad/responsible adult know exactly what needs to happen, out of the child's earshot if necessary. Yes, it will pinch. Yes, it's necessary. And most of all, it's VERY IMPORTANT that the pt. be absolutely still.

2) explain to the child if age-appropriate, but make it very simple & quick

3) I haven't seen a nurse attempt this by him/herself - get help. If it takes 3-4 people to hold the child still & distract him/her as much as possible, IMO this is less traumatic in the long run than having to stick multiple times, as long as the parent/adult was prepared beforehand.

Hope this helps somewhat. :)

jayne109, RN · Jun 24, 2005

EMLA Cream is your friend-apply 15-30 min before the stick

Recruit help-one person needs to hold above and below where you are sticking and sometimes one person to hold legs-my rule of thumb-I don't let mom or dad help hold because I want to be the bad guy, not mom and dad. Mom and dad can give hugs after it is in.

TAPE_TAPE and more TAPE-secure that puppy! You don't want to have to put that child through it again.

Be Patient-the first few times I stuck a kiddo, I had more experienced nurses in the room, but I actually did the stick. I always look really good too-it helps.

Final piece of advice-if the kid is going to be admitted, I look lower but I usually start looking in the AC space because they have good veins up there. I try to follow the vein down low to try to go lower but sometimes you have to go there because they are dry.

Let me know If I can help anymore.

Melissa, ER Nurse-level I trauma center

asher315 · Jun 24, 2005

Be honest with the child, "yes, it's going to hurt but if you are very stilll it will help. I also give permission to cry, yell or move all but where I sticking. It does hurt and I hate for parents to tell a child to act like a big girl or boy...I'm seen lots of "big" girls and boys cry and cuss. Be prepared....have everything you need right there, no fumbling for cotton ball or tape. Get any lab at the same time if needed, better to be stuck just once. Give praise afterwards, "you held very still, thank you" etc. I work in a Level II nsy and get calls from ER to help with infant sticks all the time, take advantage of others' skills as available. Hope this helps. :)

Aneroo, LPN · Jun 24, 2005

Thank you all. I was with my preceptor, who had to stick a 5yo, but she did it. I wanted to watch the first peds stick, not perform it. I remember she told him that after we put a needle in his arm, but only for a minute, then there would be a straw in his arm. It was hard, b/c there was the language barrier. (She put it differently, but I remember the straw part). -Andrea

mommatrauma, RN · Jun 25, 2005

Its alot of patience, alot of how you word it, and alot in how you prepare the parents....try not to use words like hurt and painful with young kids, like 4-7 y/o because "pain" to them is a whole lot worse than "pain" to a 13 year old...I try to talk in their words...I have a 4 year old, so I speak the language...I usually call it a little pinch, I never make no more ouchie promises until the IV is in blood is drawn and you flushed and secured the line, because you lose all your credibility with the kid if you lie...children that age also think they are special if the IV fluids they are getting is special "spider man juice" and what not to make them feel all better...I try to get all my supplies together outside of the room and not in front of the child...anticipation of pain makes the perceived pain 100% worse...so the less time you spend preparing, the less time they have to worry about it...I let parents know what's up and give them the option of staying or going...if they can't handle their child getting a needle, nothing is worse than trying to get an IV on a kid with the parents getting upset and making the kid worse...Never do it alone...at least 2 people, and when I say 2 I mean 2 staff members..because parents mean well and they want to help, but all bets are off if they think you're hurting their child. They may not be so helpful when they go to comfort the child and let go of the leg that just kicked the IV out of your hand. 2 staff members are good too because one to concentrate on the doing the IV and one to distract and then the distracting staff member can hand you blood tubes and what not so you don't lose control of your IV. Look well before you stick...Don't necessarily go for the very first vein you see...because god forbid you miss that first one you are less likely to have a kid or a parent for that matter let you spend the time to look for another vein, so know all your options from the start. The element of surprise is not all bad...The first stick for an IV isn't too bad most kids don't know what to expect, how bad it will really be, so they usually don't jump as badly...however, have to stick them a second time...they know exactly how it feels, and how much they don't like it and how much it hurts and are way more likely to move the second time around...Itty-bitties look in their feet, they often have good veins there. Toddlers, stay away from the feet, more likely to infiltrate, cause they want to be on the move...Be patient with yourself....I've been doing this for 10 years, 6 in the ER, and I still get a little nervous sticking kids, noone likes to do it...but never let them see you sweat, if you look nervous...they will pick up on it...feel nervous, look confident...and really, talk to them the whole time...Let them know exactly what you are doing...let them participate as much as they can, it makes them relax easier sometimes. Also, let mom/dad hold child until last possible minute, even while you are just looking...They still feel safe that way and are less likely to flip out early on. Be patient with yourself, it comes with practice. Good luck

jeepgirl, LPN, NP · Jun 25, 2005

Warm pack that EMLA. It works faster / better that way. I always warm pack if I expect I have to leave it on less than 1 hour.

Never, ever let a parent hold. They are unreliable. Let them be the comforters, not the person holding the kid for the stick. We love our papoose board on peds... but I do understand that some nurses (and ER's) don't like them. But they effectively restrain... and I have found that the kids resist less to even getting in the papoose if you act like it is no big deal. Just wrap up like a little burrito!

lpnstudentin2010, LPN · Jun 25, 2005

TALK to the kid while you do it. Then give them a hug afterward and say something like, "I know that hurt and I am REALLY sorry, but it is all over now and it is going to help us to make you feel better" You see I am a patient and when I got "hurt" by medical staff it always helped to hear this sort of thing.

Also, no matter what the age, if you have time for it USE EMLA. It works wonders. Put it on the back of both hands, behind the elbows, and anywhere else you might find a good vein. Put it multiple places just as a backup incase your favorite vein is a dud.

Put warmth on where you put the EMLA, this will make the veins bigger and easier to stick.

mydesygn · Jun 25, 2005

TALK to the kid while you do it. Then give them a hug afterward and say something like, "I know that hurt and I am REALLY sorry, but it is all over now and it is going to help us to make you feel better" You see I am a patient and when I got "hurt" by medical staff it always helped to hear this sort of thing.
Also, no matter what the age, if you have time for it USE EMLA. It works wonders. Put it on the back of both hands, behind the elbows, and anywhere else you might find a good vein. Put it multiple places just as a backup incase your favorite vein is a dud.
Put warmth on where you put the EMLA, this will make the veins bigger and easier to stick.

(1) EMLA is your friend. My understanding is that it needs to be applied a minimum of 1 hour prior to the stick and duration of action of 4 hours. Unfortunately, you don't always have that luxury in ER

(2) Never let parents hold. They will not hold tight enough. They don't anticipate the jerk. Hold limbs tightly at the joint, For a hand stick, the 2nd nurse should hold the elbow straight and use the joint to immobilize the arm. For an ac stick, hold at the shoulder joint.

(3) Taping is an art. Kids sweat. If available, use the "silk" tape and I ahve sometimes use mastisol to get the tegaderm to adhere to a sweaty child. Steer clear of the clear tape, I have had to re-tape many IV's from outside ER's that had clear tape.

(4) infants will typically have a good saphenous vein in their foot. Learn that spot, love that spot. You will rarely see a vein. You will have to learn to feel for them. Some people have done blind sticks for a saphenous.

jeepgirl, LPN, NP · Jun 25, 2005

(1) EMLA is your friend. My understanding is that it needs to be applied a minimum of 1 hour prior to the stick and duration of action of 4 hours. Unfortunately, you don't always have that luxury in ER
(2) Never let parents hold. They will not hold tight enough. They don't anticipate the jerk. Hold limbs tightly at the joint, For a hand stick, the 2nd nurse should hold the elbow straight and use the joint to immobilize the arm. For an ac stick, hold at the shoulder joint.
(3) Taping is an art. Kids sweat. If available, use the "silk" tape and I ahve sometimes use mastisol to get the tegaderm to adhere to a sweaty child. Steer clear of the clear tape, I have had to re-tape many IV's from outside ER's that had clear tape.
(4) infants will typically have a good saphenous vein in their foot. Learn that spot, love that spot. You will rarely see a vein. You will have to learn to feel for them. Some people have done blind sticks for a saphenous.

Saphs are good but you have to use some sort of board to restrain (we use an armboard) or its pretty useless... it'll be out or infiltrated. For the taping... we use clear tape all the time, and prefer it on our floor. We tape ours so that they do NOT come undone until we want them out... and we rarely use mastisol. And if you have to use mastisol, DO NOT dc it without using adhesive remover. That is very painful and bad for the skin.

mydesygn · Jun 26, 2005

Saphs are good but you have to use some sort of board to restrain (we use an armboard) or its pretty useless... it'll be out or infiltrated. For the taping... we use clear tape all the time, and prefer it on our floor. We tape ours so that they do NOT come undone until we want them out... and we rarely use mastisol. And if you have to use mastisol, DO NOT dc it without using adhesive remover. That is very painful and bad for the skin.

Question about the clear tape. Is your peds floor part of an adult facility or is it a freestanding pediatric hospital? I've worked at freestanding pediatric hospitals and never seen the clear tape, however because the adult hospital tape their IV's differently, the same taping style is used for any peds patient that come in.

You do use saph veins alot course we get a lot of kids with chronic illnesses that have very few better options.

jeepgirl, LPN, NP · Jun 26, 2005

Question about the clear tape. Is your peds floor part of an adult facility or is it a freestanding pediatric hospital? I've worked at freestanding pediatric hospitals and never seen the clear tape, however because the adult hospital tape their IV's differently, the same taping style is used for any peds patient that come in.
You do use saph veins alot course we get a lot of kids with chronic illnesses that have very few better options.

I work in a regional medical center in a closed peds unit that only does kids... we're not an adult / peds floor, etc. But no, it's not a childrens hospital.

I guess I should clairify. What we tend to do is we use the clear tape under the tegaderm to stabilize/secure the hub. We then we use foam to tape to armboards and reinforce that with the plastic if needed. From what I was told, we stopped using the silk on our floor because we had a lot of kids with skin irritations / rashes due to it. Who knows, it could have been a bad batch. Anyway... we do try to only use the plastic against the skin at the site to stabilize and then try to only use the foam everyplace else.... it is softer and less irritating. Now, I didn't say that silk tape is WRONG... we just prefer plastic under the tegaderm and foam on our floor.