Venipuncture on peds

[missnurse89]

I am an RN, PHN. Where I work, we occassionally get a peds patient for venipuncture for lead sampling. I draw blood daily on adults, I immunize and perform finger sticks on kids daily as well, but I don't perform venipuncture on kids hardly ever. The last time I placed an IV on a ped was 3 years ago, and I feel that IV insertion and venipuncture are two different stories.

So, I am asking for advice. What has helped you with ped venipunctures? Any tips are appreciated. Thanks :)

[Jamuhh]

I am not sure what would be different about sticking a child vs an adult except for the size of the veins and their reaction to you trying to stick them. If you're worried that you will miss, use a warm pack or warm blanket to dilate their veins, and use a smaller needle. On my floor the biggest we use is a 22g for IV starts. I believe the butterflies are 23g. Sometimes the older kids get 20s during transport.

As far as their reaction, you probably could use someone else in the room to help distract them. Most kids are very good at playing on iPhones or iPads, or will enjoy a nice toy.

Was there something specific you were wanting advice on?

[missnurse89]

I am not sure what would be different about sticking a child vs an adult except for the size of the veins and their reaction to you trying to stick them. If you're worried that you will miss, use a warm pack or warm blanket to dilate their veins, and use a smaller needle. On my floor the biggest we use is a 22g for IV starts. I believe the butterflies are 23g. Sometimes the older kids get 20s during transport.

As far as their reaction, you probably could use someone else in the room to help distract them. Most kids are very good at playing on iPhones or iPads, or will enjoy a nice toy.

Was there something specific you were wanting advice on?

Thanks for the great advice! I think it's just uncertainty because their veins are so tiny. I used to do IVs on peds several years back. Now I am performing venipuncture on peds. I draw blood daily on adults for several years now. It seems different and a little more challenging but I think it's just gonna take getting into practice for this. The kids we stick are around 1 and 2 and their veins just seem to be so tiny. Even with a small needle I find myself doubting that I will hit the vein. Maybe just practice and telling myself that I got this.

[Jamuhh]

You will get it :) & definitely use a warm pack or blanket if you have it. Good luck

[LoveMyBugs, BSN, CNA, RN]

Practice!

Hands are really good on kids

Distraction

And a really good holder, always about the hold.

Watch out for feet with toddlers, many times I get a flash and then they kick their feet or push up with their feet and I would lose the vein.

Toddlers most likely won't be able to distract 3 and up you might be able to distract with an iPad/video or something

[NurseStorm, BSN, RN]

Venipuncture is easier imo than IVs. I would always use a butterfly, have someone hold the child in a hug like position and hold their arm out. We always tell our kids they can make however much noise they want, but hold your arm still. This doesn't always work, but is pretty helpful most times. I agree with warming the area, also the distraction with iPad, etc if possible.