Who uses scalp veins in babies?

[wandernsoul]

Never had to question this before in all my ER years. Had a 16 month old with persistant vomiting, chunky but nearly bald little girl. As we (another traveler and myself) were looking for IV sites the mom commented on the child's scalp veins, which were quite prominent since she was such a little cueball (a very cute cueball!) After several peripheral attempts that were unsuccessful the other traveler was ready to jump on the scalp vein, or a foot vein. I mentioned that we might need the docs approval (I don't know this hospital's policy). She seemed quite miffed by this but spoke with the doc who was less than anxious to go either route (bear in mind this child had been sick for about 2 hours and not looking "scary sick"). I gave her a Tigan supp. , started giving her sips of Pedialyte, and reported off to the other traveler as my shift was over. I'll find out today what happened. But my question is:

Do any of you use scalp veins in kids? If so, is it policy or requiring an MD order?

Thanks much.

Beck

[CougRN]

I have seen this done quite often especially in the NICU. Why didn't you try IO?

[veetach]

OMG you dont want to do an IO on a conscious patient, if you can get a scalp vein instead.

[CougRN]

where in her post did it say the child was conscious?

[dawngloves, BSN, RN]

Don't need an order in my hospital for a scalp IV.

I don't know why so many are apprehensive about scalp veins. If it were my kid I would preffer it for the reasons Jolie mentioned.. I think parents wig out because they imagine a needle is in their abies brain.

[BarbPick]

I thought IO is the last resort.........

[Jolie, BSN]

CougRN,

In the initial post, she mentioned that the baby did not look "scary sick", and since the doc was not eager to try either a scalp IV or PIV in the foot, she gave the baby a Tigan supp and sips of Pedialyte.

I assume that the baby was conscious.

I agree that IO would be major overkill in this circumstance.

[CougRN]

Use of intraosseous infusion in the pediatric trauma patient.

Guy J, Haley K, Zuspan SJ.

Department of Emergency Services, Children's Hospital, Columbus, OH.

Intraosseous infusions (IO) are frequently used for gaining rapid vascular access in critically ill children. Few studies exist evaluating the efficacy of this procedure in the injured child. The objective of this study was to describe one pediatric institution's experience with the procedure of IO in young trauma victims. This study evaluated indications, insertion sites, complications, infused pharmacological agents, age, injury severity, and outcome. Fifteen patients received IO placement for cardiopulmonary arrest, seven for hypovolemic shock, and five for neurological compromise. Patient ages ranged from 3 months to 10 years (mean, 2.9 years). Twenty-nine IO lines were attempted in the tibia and three in the femur. Four of 32 attempts were unsuccessful. Of 32 attempts at IO placement (5 patients received multiple attempts), 15 were started in the prehospital setting and 17 in the emergency department. Multiple resuscitation medications as well as large colloid, crystalloid, and blood boluses were successfully infused. Seven of the 27 patients survived without observed IO-related complications. This study supports the use of IO infusion by prehospital as well as hospital personnel in the initial resuscitation of critically injured children. IO has a been established as a rapid, safe, and simple method of obtaining short term vascular access in both critically ill and injured children. This route deserves primary consideration as an alternate route for fluid resuscitation in pediatric trauma patients regardless of age. B] IO should be placed without delay when venous access is not rapidly obtainable.([/b]

[kc ccurn]

IO's are a great access for kiddo's, but they are really a last resort and for a short time only until alternative access can be made. Scalp and foot iv's can stay in longer than an IO can.

[veetach]

CougRN I am not sure where you are going with the article on IO's. Every PALS nurse knows that an IO is the last resort for access in a trauma or critically sick child. The child, in question on this thread is not a candidate for an IO.

If I have misunderstood, please accept my apologies...

[wandernsoul]

Just to clear up any confusion, the baby was indeed conscious so I never considered an IO. She was taking sips of fluids, but still vomiting.

I do only ER, never done Pedi, and certainly not NICU. I've worked for 16 years in ERs, dealt with lots of sick kids, but call me fortunate I guess, have always been able to get a peripheral IV or had a coworker who could, so I've never had to go the scalp vein route. Perhaps it's just the thought of it......I was hesitant, never having done it. In the end I deferred to my coworker who did end up using a scalp vein. It's all about working together, right? And learning new things.

Thanks for all your input. It's been very enlightening.

Beck