IV's on peds

Shishkabob

Shishkabob

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Tried searching, didn't find anything much pertaining to peds and IVs.


My first clinical is at the childrens hospital ED. I do pretty well with sticking 25-30y/o adults, but have never had to stick a child. I do know(hear) they are hard sticks though.


Any tips? Specific sites you tend to see better veins at (Like the AC on adults)?
 
I haven't done a huge number of peds like some of the other members, but of the ones I have done, I've noticed good ACs.

Obviously, keep the child calm, talk to them about what you're going to do. I've gotten good responses when I take out an angiocath, show it to them, retract the needle, and then show them the soft catheter that will be left into their arm, and let them touch it to see it's soft if they want. They seem to be more accepting when they realize it's just a small plastic catheter.

If they're schoolaged, and comfortable with the parents... I'll have the parent hop up next to them and help calm them.
 
Linuss said:
... I do know(hear) they are hard sticks though.


Any tips? Specific sites you tend to see better veins at (Like the AC on adults)?
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Not so much hard sticks (access wise) as they are moving targets. Setting the stage is important, as Hotel stated... but sometimes there is nothing you can do to placate an apprehensive child.

My favorite has always been the back of the hand, I start there and work my way up. The AC may be preferred by many, but as far as stabilization prior to insertion goes, the pronation/supination of the radius and ulna can wreck havoc on trying to anchor an AC vein.

Have plenty of holding help on standby, and consider use of a papoose.
 
Linuss said:
Tried searching, didn't find anything much pertaining to peds and IVs.


My first clinical is at the childrens hospital ED. I do pretty well with sticking 25-30y/o adults, but have never had to stick a child. I do know(hear) they are hard sticks though.


Any tips? Specific sites you tend to see better veins at (Like the AC on adults)?
Click to expand...

Kids have a lot of baby-fat the younger they are, and that can definitely make it difficult. I actually keep one of those little stress dolls in my bag, the ones where the eyes and ears pop out when you squeeze them. Kids get a kick out of that, squeeze away, and it usually brings the veins up a little bit for me.

As mentioned above, let them know what's going on. I don't usually show them the needle, just the cath, because regardless if it stays there or not it usually scares the crap out of them.

I one time faked an arm-wrestling match with an eight year old. Got him moving and sweating, pretending like I couldn't beat him. Hot his blood pumping for me, and I told him after I got the IV going the bag of fluid would make him even stronger. He was dehydrated, so I wasn't really lying...

As far as critical peds patients, like a crash or severe allergic reaction, we usually try two IV's and then go to the EZ-IO. I've never done it on a conscious patient, peds or otherwise, but I DID witness a 45 year old fat man with a possible (likely) stroke get a conscious IO in the shin. Holy crap was he not happy. Can't imagine doing that to a poor kid, but I suppose I would if it came down to it.
 
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Like it was alluded to before... distraction, distraction, distraction!

I find it easier to not let the kiddo see the needle at all. Kinda like a patient who's going to be decompressed with that huge 14 g --- don't just dart him like you're gonna stab that roach on the table! For kiddos, I guess I also appear to be the mean ol' graying witch on the truck. Kids just don't like me right off the bat, no matter how sticky-sweet I try to be, lol! Seems to be the same effect on the drunks (er, ETOH+ patients)... but anyway. :rolleyes:

My partner has something like a gazillion little cousins and nieces himself, so he's my kid-expert and "distraction" with whatever funky-looking stuffed critter we have stashed away in the cabinet. I'll stroke the kid's hand or arm downward after the tourniquet has been applied, not only to desensitize them from the impending doom a little bit, but also to see what might fill a bit as a potential IV site. Alcohol prep scrub, a little more stroking of the arm above the potential site it so the alcohol dries without contamination, and "lil' poke". Done. Hopefully.

Only works in the most ideal of circumstances. Hard to believe, but there's even some kids immune to my partner's charisma and charm. :P
 
Aliakey said:
For kiddos, I guess I also appear to be the mean ol' graying witch on the truck. Kids just don't like me right off the bat, no matter how sticky-sweet I try to be, lol! Seems to be the same effect on the drunks (er, ETOH+ patients)... but anyway. :rolleyes:
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I used to be able to charm any kid to do anything I wanted. I was great at getting them to laugh, calm down, and even let go of their parents!

Then, I shaved my head. I got tired of sweating all over my patients in the summer, and it was my attempt to cool off before it got to that point. Unfortunately, a bald head apparently makes me look like every cartoon villain they've ever seen.

That, or the example the man they show on the stranger-danger films they show at school.

Either way, they are terrified of me now. I can still usually get them to like me after a while, but I really have to work it now.
 
Childrens Hospital ED nurses will be your best resource.
 
Sorry but did you mean IV as a plural word or IV as a true contraction?

IV's= "IV is" or stating something belongs to the IV
IVs= Plural of IV, such as "I have started many IVs as a paramedic"

Pet peeve. Sorry.
 
PapaBear434 said:
...they are terrified of me now.
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So your patients are too? Phew, I thought there must be something wrong with the care I am providing!

... sorry bro I had to say it, I just couldn't resist :lol: :lol: :lol:
 
OldEMT said:
Sorry but did you mean IV as a plural word or IV as a true contraction?

IV's= "IV is" or stating something belongs to the IV
IVs= Plural of IV, such as "I have started many IVs as a paramedic"

Pet peeve. Sorry.
Click to expand...


NICE! :D

Get used to it... this place is an English teacher's worst nightmare (most forums are).
 
OldEMT said:
Sorry but did you mean IV as a plural word or IV as a true contraction?

IV's= "IV is" or stating something belongs to the IV
IVs= Plural of IV, such as "I have started many IVs as a paramedic"

Pet peeve. Sorry.
Click to expand...

You registered just for that?


Ironically, you forgot punctuation as well.
 
ptemt said:
Childrens Hospital ED nurses will be your best resource.
Click to expand...

Spot on and I agree 100%. I know it has been discussed before that most programs do not allow near enough clinical time in a peds only ER setting. The programs in my area allow 12 hours in the peds ER and 24 hours upstairs on the floors. I really hope that with all the calls for better education that this is one area that gets a good close look. Students need more time to develop their skills and learn how to work around sick or injured children. I really hope to see more peds ER clinicals for medic students in the future.

When I first started working as a tech I pulled as many shifts on the peds side as I could get,which lead me into the peds ER tech position I hold now. There is not a shift that goes by where I don't pick up some useful bit of information. Working with the all peds staff at least in my level one facility presents on outstanding setting for increasing my level of confidence and knowledge when working with peds in the field.

I would like to offer some advice to help you get the most out of your shift or shifts. When you do your shift be prepared to soak up alot of material and ask as many questions as you can. If you have any areas of concearn or topics that you want adressed this is the time to do it. I will warn you that peds ER nurses tend to be very protective especially when it comes to the youngest patients. I have yet to see a student do an IV start on an infant or a child that is really over anxious and having a rough time of it. You have to understand that the parents of a sick child in the ER are often our second and third patients and can often be more of a problem than the sick child. It wont matter if you don't get any lines yourself just being there and learning by watching will be enough. You may give meds help with assessments get vitals and assist with procedures. Bottom line be on top of your game and ready for a quick shift it will be over before you know it. Have fun and enjoy what I'm sure will be a great learning experience. Let us know how it goes.
 
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Depending on age of the kid some are like little adults as far as venous access some you have to search harder for. For real little ones I have found the scalp easiest then I usually look for hands or feet.
 
Easiest Peds IV I've ever done was a 3 year old who drank 2 oz of Triamenic. Took him a moment to realize I'd stuck him... then he looked at mom as if to tell her that I poked him... and then he just didn't care...
 
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