Starting IV's in babies/kids

[RoyalNurse]

Hi everyone, I'm 0 for 4 so far in starting IVs in little kids (under 3), I can do 4 and up. I can get a flash return, but something happens when I try to advance in these little kids. I try to get a good holder, I tape the arm up first on an arm board (with lots of kerlix and padding), and I bundle the kid up in a sheet and have the parent stay by the face and hold the arms down. I usually end up in the room for 1 hour to 1.5 hours while getting various other people to come and "try" the IV.

Any tips from anyone are appreciated in advancing that catheter in baby IVs.

THanks!

[FlyingScot, RN]

There are several threads that have great suggestions for pediatric IV starts. You might want to take a look at those first. Also, I don't like having the parents participate in the restraining part...it makes them the bad guys and can actually increase the stress level because it confuses the kids. Having them at the head stroking the child and offering comforting words is far more beneficial for everyone.

[PostOpPrincess, BSN, RN]

Very difficult to "talk"..I am a tactile learner and teacher....

sorry...

[Footballnut]

If it is the small veins that are giving you trouble keep the bevel facing up toward you when you are entering the vein. Keep the vein still with enough traction. As soon as you get a flash visualize the bevel sliding along just under the top of the vein a short distance being careful not to go through the back of the vein. Maintain your traction while you do this. You can even slightly lift up on the IV putting a little tension under the top of the vein to be sure you are not going through the back of the vein. This requires you to be almost level with your vein rather than at much of any angle. After you are sure you have advanced the IV a little into the vein you may slide the catheter off the needle. If you try to slide the catheter off before you are far enough in you may get a flash and still not get the catheter to remain in the vein.

Also, try a lot of IVs on small adult veins so your confidence level is better when you are working on those little guys. I expect my peds and infant IVs to be in by a few seconds to limit trauma to our smaller clients. Even if you use a topical anesthetic prior to starting the IV the less fuss the better.

[Lunah, MSN, RN]

I think a lot of it is just experience and practice. Footballnut has a lot of good suggestions, too -- I think a lot of people advance the needle much further in than necessary to thread the catheter, and end up outside the vein, making it impossible to thread.

I've also found that good holding help is invaluable. I typically swaddle kids in a sheet as well, telling them I'm going to make a "little Susie burrito," or whatever. I never ask Mom/Dad to help hold -- the parents are there for comfort only (although I do give them the option of stepping out, which they typically decline), and the minute I'm able, I unwrap the kiddo and let them hug Mom/Dad. I also praise Mom/Dad as well as the patient, because this is tough on them as well. I sometimes see more tears from the parents!

If you're looking in the AC space, kids can bend their arms in amazing ways like little spaghetti noodles, so really have someone that can hold that arm/elbow still. A kid can have the greatest veins, but you're still going to blow them if you can't hold them still. I piece the skin kinda slowly (but not agonizingly so, if you know what I mean) to give them a little time to wiggle, if they're going to do that, and then I proceed toward the target.

I spent almost 4 years as an ED tech before I became an RN, and I was often the "preferred peds poker," which gave me a lot of practice. :) Good luck!

[czechchickieeRN]

Great advice - thanks! I'm a new ED RN and got my first 6yo peds IV stick last night so I'm 1/1. (yay!)

[canoehead, BSN, RN]

Sit down when you do the stick, and spend at least 5 minutes looking all over for the best and easiest vein. Lots of wrapping and unwrapping and talking to the child and parents. Then lay everything out the way you want it, wrap the child with a holder and get your limb in the best possible place. Make the "stick" to get under the skin quick, and give the child a minute to yell/move. Then go for the vein slow but sure. Once you get in the vein people relax and start to unbundle the child or release their hold.(NO!!) Make sure you tell them to stay put until everything is taped, reinforced and secure.

[MassED, BSN, RN]

you need to have someone (a nursing assistant) hold the arm. Whomever holding is key to quicker and easier IV access by properly stabilizing, while staying out of the way of where I need to hold and manipulate. In my experience. I wouldn't use a parent to hold.