interesting scenario

[Pablo the Pirate]

ok just to make long story short and give a little background on why i even ask. my cousin had a baby the other day. shortly after baby was born some problems came up. i can't say exactly whats wrong because i just dont know. that particular side of the family is completely medically ummm we'll say challenged. so i know alot of what the docs are telling them and then my cousin tellin me is lost in translation. the one thing they told me for sure that they understand is that baby's blood was clotting. baby was born at a small terrible community hospital and needed to be transfered to a big hosp. so small hosp. calls big hosp 2 hours away and big hosp sends a ground ambulance to pick up baby. I can only hope and assume that big hosp sent their own ambulance because they put specialists on board. ok so now the questions and opinions part. My cousin said that the folks at the stupid little comm. hosp couldnt start an IV on the baby. they tried 3 times and didnt get one. excuse being the baby's blood was to clotted or maybe clotty to start an IV. so medic shows up and after unknown attempts finally got one in the babys scalp. ha ha take that you nurses. anyway how far would you take trying to get an iv before you just get an io? if the blood was so clotty why not just do an io? what would you have done?
and for anyone that wants to know baby seems to be getting better now.

 

[KEVD18]

if the baby needed access that bad, i would have gone directly to io without a vein jumping right out at me.

 

[jeepermedic]

if it was me on the truck that came I probly would of gone straight to the IO, since the baby had been stuck so many times. From what my instructer tells me it depends on the person as to how many times you stick before going to an IO, I you want to stick 10 and have a mad baby go ahead. I would stay with about 2-3 sticks before IO.

 

[RALS504]

I would have tried the IV a few times. I get IVs on pediatric pt regularly in ER. I got a 24 ga on a 7 month old last monday and the youngest pt I have gotten an IV/blood draw on was a 5 day old. The 5 day old pt I was slicing the skin with the 24 ga angiocath. much like a scalpal rather than a needle. One must remeber that getting an IO on a newborn will be much different than on a pedi pt due to softer bone density (cartilage). By the way I would probably cut the RN some slack it was a newborn, not a 18 y/o you are put a 14 ga in an ac.

 

[Ridryder911]

Sounds like the infant may have Polycythemia (too many RBC's), which is technically defined as a central venous hematocrit (Hct) > greater than 65%, and usually is a common disorder. The primary main concern with polycythemia is related to hyperviscosity (thickness of the blood) and its associated complications. Blood viscosity increases as the Hct rises above 42%. This hyperviscosity is thought to cause the symptoms seen in approximately 1/2 of infants with polycythemia.

Their reason for not being able to establish an peripheral IV could be valid. Scalp veins are okay, but one needs to remember that it may have to be large enough to transfuse blood later. Personally, I would had attempted the greater saphenous vein (distal talus on the ankle). If possible the physician, neonatal nurse practitioner, transport team, should start a central line, since this will have to be a long term dwelling line.

Intraosseous has their place, however; I have yet met many neonatologist that approve of I/O unless the child is "crashing" or in arrest situation. I personally will attempt 2 sticks, then an I/O on a "real sick" child. Much concern of using an I/O on an infant that size is the epiphyseal growth plate, and osteomyelitis. Even infusing fluids, and med.'s is difficult in I/O and usually requires pressure bags, compound this to having to infuse something thick..

R/r 911

 

[Grady_emt]

If the baby was still a real new neonate, and the umbillical cord still had the "stump" part attached to the baby, could they not have used the baby's umbillical for the access?

 

[Ridryder911]

This could be something to consider. Personally, I only to prefer to umbilical venous catheterizations (UVC) on new neonates, and my personal experience is very limited on this.

When researching, I cannot find the end age limit, when not to attempt a UVC. I would think, that it is dependent upon the "stump" and the ability to re-open it, etc. Remembering this is a dangerous process, (as all UVC) and has a history of high incidence of sepsis, and infection rates as well catheterization of the liver has been documented. From what I have read, they are suggested to be used only for 14 days and should have an on-line filter.

I agree, this was something to consider; however doubtful a routine physician would want to make this type of decision. The speciality transport team might have experience in such, (i.e. neonate nurse practitioner- NNP). I know our "kids" team, has a NNP, that routinely places UVC in. Probably has more experience doing so more than any physician.