Tips for Starting IVs in Level II neonates

suzanne4, RN · Dec 15, 2005

If I use a hand or foot, I usually do not use a touniquet, I just use my other hand as one, if needed, works for positioning as well. If a tourniquet is actually needed, a rubber band cut in half is much easier, or yo uneed to cut a regular tourniquet to about the size of a rubberband.

Veins are usually located just under the surface, and you need to position just above the vein and then puncture the skin and advance it inside the vein, once you have a flashback. The nice thing about infants that small, is that you can "see thru them."

It really just takes practice, and all of the videos or anything else really doesn't work, just the actual trying.

minniemiteRN · Dec 16, 2005

The key here is practice makes perfect. Practice, practice, practice!! I worked in adults before coming to the NICU so I was more than a little terrified to start poking around on tiny preemie veins.

I'm sorry but I don't know of any books or any education materials to help you. My favorite IV sites are the hands and if the infant is a hard stick with a lot of blown veins scalp veins are good too...scary for parents but they tend to last longer than peripheral ones.

Good luck!! :rolleyes:

dawngloves, BSN, RN · Dec 17, 2005

I always look at the feet in big kids first. No fat there and the veins are easier to visualize.

I think you just need to practice. that's the best way to learn what way works for you. I was trained to use a transluminator, but I found I was better without it.

Mimi2RN, ASN, RN · Dec 17, 2005

If you need a tourniquet, a piece of 1/4 inch penrose drain tubing works really well. We keep a box with our IV supplies, and cut a piece a few inches long. Rubber bands are good for scalp IV's, keep scissors handy to cut it off when you have a flashback.

If you are new to this, always have someone help hold the baby. That can be half the battle, as it's much easier having help taping the IV in place.

Equipment is important, different size arm boards are helpful. We usually use plastic tape, but add either a folded 2x2 or a cotton ball dabbed on the sticky part which will prevent the tape from sticking too much to the upper arm or leg. We use Veniguards to cover the site, so the actual cath site is visible, but the IV is snug. We also use a short T-connector with a 5 ml syringe of saline attached start the IV, then connect the tubing with a Lever-lock. One place I worked didn't use those, I was really glad when we got them. I've seen people use a syringe of saline to float the catheter in, but then it has to be separated to attach the tubing.

We usually tape the babe's fingers together, I use a half inch wide strip of tape, maybe 2-3 inches long. It's easier to keep them in place like that, and you can still see that they are pink.

If you are using the hand, fold the baby's fingers to the palm, so you are holding the wrist and fingers, with the back of the hand in place. When you have prepped the site, go in at a very slight angle. Unless you have a 10lb chub, the veins are right below the surface. If the catheter won't advance when you have a flashback, attach the T-connecter and have your partner try to flush it in.

The saphenous vein inside the ankle is usually a good place to start, although you can't always see it. Start feeling for veins, often the big ones in the AC and the ankle can't be seen. Those skinny little veins on the foot will surprise you, if you see a straight one, go for it!

The last thing is the taping. Always leave the site visible, if you use Tegaderm or a Veniguard, or whatever, DON'T tape across it. If you can't see the cath insertion site, you can miss an infiltrate until it's a nasty problem. I tape the upper arm, then across the fingers, with usually two narrow strips of tape in an X so the thumb is free but the hand is down. Sometimes I'll put a narrow strip at the top of the Veniguard, and also across the hub, if a little pressure is needed.

OK, maybe you didn't need all that, the main thing is practice, practice. If you have someone in your dept that's good, watch what she does, and ask for suggestions. Good luck!

prmenrs, RN · Dec 17, 2005

When you're taping a hand, don't try to tape the fingers flat, have them "grip" the end of the board--take advantage of that grasp reflex. If you tape it flat, the baby will fight to get his fingers free b/o of that reflex, it's not natural to have them flat.

If the hub of the IV extends beyond the edge of the board, build it up underneath w/cotton balls.

Two narrow strips of tape can act as "chevrons" under and around the hub can help it stabilize it.

I have never understood the thing about keeping the thumb free. If it was an older baby/child who needed his thumb to suck, great, but newborns and premies usually haven't learned that trick yet (altho I saw one the other day who had it down really well), so don't worry too much about not taping the thumb.

SteveNNP, MSN, NP · Dec 20, 2005

What initially caused me trouble when starting IV's in preemies was that I was taught in school to drop the needle's angle and push it in a little farther when I got a flashback. This usually won't work in babies, because their veins are so small. just slowly advance the CATHETER, not the needle once you get a flash. Also as a word of advice, ALWAYS feel for a pulse when you are sticking the scalp or AC. I had one accidental temporal artery stick, and it scared the crap out of me when I flushed it and his whole face blanched. woohoo....hope that never happens again!

davery · Apr 30, 2012

neonates are nothing like adults when it comes to IVs. Think of it like giving a TB test you don't want to go too deep. scalp veins are the best they have better perfusion. I never use a tourniqute I use my hand to stabalize the vein and use minimal pressure. Do not thread too quickly it will blow. If they have an increased hgb or increased bili they can blow easier. always have two people with neonates one to secure infant and aid with stabalizing the IV once threaded. Try not to use sites that are good PICC sites like the AC or Saph vein. I always us an 56 IN. Do not over pock the infant if you cant get it within 2 tries have another nurse try if they fail consider a PICC placement or UVC depending on the fluids and duration the line will be needed. If you try to anchour the catheter like a TB you should get the vein, but its all about threading it and flushing slowly to keep the PIV in place. always flush while taping. When using scalp veins catheter always needs to be pointed down towards the forehead. When taping scalp PIV's use cavalon,than tegaderm, paper tape smoothered in KY jelly. Chevron it than make a U both directions with paper tape.Apply extra KY over taping when complete. Swaddle infant tightly to allow KY to dry. Note that infant veins are fragile and small they do not last long. Check IV site often they can have problems fast. If you are doing long term therapy then have a Umbilicus veinus line placed or PICC. I change my IV's at lest every 48-72 hours if they even last that long. Hands and feet last least amount do to movement and kicking. Scalp Ivs look bad but are less painful, more secure, and last longer.

NicuGal, MSN, RN · Apr 30, 2012

You guys change your IV's even if they don't need changed? We had it written into our protocol to leave the catheter for how ever long it is good. We also aren't allowed to use surgilube on IVs....it is a medium for bacterial growth. Our unit policy is if they are going to be on IV over 5 days or have been stuck 6 times for one IV then they get a PICC from either our fellows or IR comes up and places a fem line.