IVs for pediatric pts

Voodoo1

Voodoo1

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Does anybody have any tips/tricks for starting IVs in pediatric patients? I'm having a little difficulty finding and sometimes even feeling the veins in younger children (4 and under).
 
This topic would get a much better response in the ALS Discussion category.
 
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Finding a vein in a kid's arm works the same as grownups, but the tiny veins buried in the pudge can be slightly tricky.

First step is to get over the kid drama- it's just another vein. You want to get in there as badly as you want to get in any other vein, and they behave just the same.

Get your partner to hold the whole arm still, and look either in the back of the hand or the AC at first. If you flex the wrist so the hand makes a 90 degree angle at the end of the arm, there is usually a vein right in the middle of the wrist. This is the easiest one to hit on infants and neonates, IMO- and just like sometimes the veins under a person's watch arm more exposed than the open skin, the veins sometimes show better in the crease of the wrist of rubber band wrist babies.

In the AC, sometimes hyperextending the arm will help you see the vein and feel where it runs, but letting it flex a little when you stick makes it less flat. Make sure you have an armboard ready that's appropriately sized. Ask me how I know that trauma sheers will cut through a 3-ring binder in a pinch to make a tiny little armboard. :)

If no vessels are showing up at all, you might try a hot pack on those areas, or look in the foot. Again, they are all just veins. Don't be scared of them just because the patient is screaming at you. Stay cool, keep talking the whole time, and work quickly. When you find a vein, make a decision quickly about whether you are going to stick it or not, and then get 'er done.
 
Get an embryology book.

Vascular is not formed magically, it follows predictable patterns.

There is some variation, but almost none in the proximal extremities.

Knowing where the veins are likely to be is the first step.
 
Another way I've done it is dim the lights and use a flashlight up against their skin or on the palm of their hand shining through to the back. The veins will show up as dark lines.

Be very cautious about how long you use this technique. Flashlights can heat up pretty quickly. If you want to make a situation worse, let your light get too hot and burn the little one and see how happy that makes them and their family.
 
Second for saphenous vein if nothing is easily visualized elsewhere. Heatpacks sometimes help. Otoscopes work wonders for transvenous illumination. Bigger isn't better for peds, you can given blood etc through a 24 so go with what you are confident you can get instead of attempting to be a rockstar and blowing a 22ga or 20ga attempt.

Armboard, armboard, armboard after line is inplace. Check for infiltration often. Not a fan of gauze, diapers, Co-flex, etc over the actual IV site. Also for foot IV's bend a large armboard in half to secure them to the foot like a splint.
 
Patience. That's my trick. Pediatric vasculature is smaller han adult so give them time to engorge with enough blood to be palpated.
 
Thank you all for the responses. I think my biggest issue was the kid drama. To Vene, I think I'll be following your advice.
 
Big thing to remember is you're causing a bit of pain to make the little tyke feel better, either immediately or down the road at the hospital. I know it sucks to cause pain to a little kid who's already upset but you can't let that impede on you providing the necessary care to that child.
 
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