Still get anxiety with peds IVs

LoveMyBugs, BSN, CNA, RN · Aug 7, 2016

I work in a peds ED and fluffy babies 4 month -18 month crowd is the hardest to get the line. Give me a 10 day old or a 10yr old no problem.

Do you have help holding? We always take 2 people to start a line usually it comes down to a good hold, they will ever so slightly twist their arms and the vein in the AC will hide.

Once you poke through the skin...wait a second or 2 or 3, let them cry and then wait for them to take a breathe. Veins will break or vasoconstrict when the pt holds their breath, adults you can poke through the skin and go right into the vein in one swift motion, most kids you can not.

Scalp veins are great veins, it looks bad to parents but a vein is a vein. And if I see a scalp but do not see anything on hands or feet or AC I will go for the scalp.

i tell parents I would rather do it once and get the vein I can see, than possibly having to go more than once.

Feet are great on the fluffy non-ambulatory

On fluffy babies, you most likely will not feel a vein but might be able to see one. hot pack the areas, hands, feet, AC and then take an alcohol wipe and wipe the skin and look for a shadow.

Does your unit have a vein finder?

Does your hospital belong in larger system that has a pediatric hospital? Ask to spend some time on a unit or with the IV team to get some hands on. We have done that in my ED to other Nurses from hospitals within our system.

You will get better

iluvivt, BSN, RN · Aug 7, 2016

Please only use the heal warmers or warm packs specifically for this use. You may also want to ask for a vein light. They are relatively inexpensive and very helpful. The one my coworker has only cost 250 dollars I have so may tips I can give you and a plan to get better at this but I must get a few hours of sleep before my next shift. I will get back to you but I would like to know what brand and type of catheter you are using? It does take a lot of patience and practice and a plan of action to improve. It sounds as if you are very motivated

CryssyD · Aug 8, 2016

Take your time. Once the baby is secured and can't jerk its arm or leg away, be very slow and very gentle. Never advance the needle after you get a flash--you'll blow the vein--and then hold the needle steady with one hand while gently advancing the catheter with the other (I know most people use a one-handed advance with the index finger, but I've had much, much more success using both hands). I've heard fellow nurses advise inserting the needle bevel-down to decrease the probability of piercing the vein--I never had much luck with it but some people do. Don't worry about getting the biggest possible line, even in serious situations--get a line of any size, then you have a way to hydrate so that further access (peripheral or central) will be easier. Above all, remember that if you can see the vein it is very shallow, and so your angle of insertion is going to have to be extremely shallow as well.

As far as the chubby ones, try areas where there is typically less subcutaneous fat--the ACF, inner wrist/lower forearm, and, of course, the scalp. Finally, study basic vein anatomy: the great saphenous vein that runs just in front of the medial malleolus and down across both sides of the top of the foot is the pedi nurse's best friend, and the cephalic vein in the outer wrist is usually a reliable stick too. I've never tried a vein illuminator--in the old days, we used a regular flashlight, and sometimes it worked, so that's probably worth a try.

Of course, the best way to learn pedi IVs is practice, practice, practice. Good luck!

**NickiLaughs, ADN, BSN, RN** · Aug 26, 2016

Thanks for the tips. I guess practice is the issue when we don't get to do them very often. If my assignment only provides me maybe a once a month opportunity, therein is my problem. I'd try other nurses patients but I'm usually so busy in my assignment I never have time to ask. There is no peds hospital in our system. We use BD nexiva which are terrible IVs to me compared to insytes that I've used other places. I feel like they pinch a lot more and are difficult to smoothly insert.

we don't have a vein illuminator.

I do get someone to help hold but those kiddos seem to wiggle real good and just that slight movement alone has cost me a couple of the lines.

WoosahRN, MSN, RN · Aug 28, 2016

You've gotten some great advice here. I've been in PICU for 9 years and I'll tell you my weakest area are the 3mos to 15 mos (give or take). Fluffy and chubby are the toughest even with tools. I'm also really bad at ACs (got figure) and love feet on those little ones. Yet ironically feet can be the toughest due to wiggling. A good hold is honestly the most important part. Get a couple people (never underestimate those little ones) and get that limb clamped down. I would say that if you don't feel or see anything or don't feel confident, ask someone else or get help. Even with experience and having regular peds poking opportunities, if I can't find anything, I find someone that does (though I understand this depends on your environment and being able to get help).

BittyBabyGrower, MSN, RN · Aug 29, 2016

On babies, even chubsters, the saphenous ia usually pretty juicy. Put a tourniquet about midway on the calf and it should pop. Once you get the landmarks for it, it is a great blind stick spot.

Scalps are are awesome also, but make sure to mitt them!