Baffled in Brooklyn

Jan 9

Tips For a Successful Pediatric IV Insertion

I guess most of these tips are really applicable to any IV placement, but since I’m a pediatrician I’m including some extra tips that a re pediatric specific. Also, it’s my blog and I can do whatever the heck I want. I’m talking about a routine IV placement here. Obviously in an emergency situation things work differently.

1. Go to the procedure room
Most pediatric units have a special room to take kids to when they need blood draws, IVs and other bedside procedures. There are a few reasons for this, but the main reason is so the child knows that his bed and his room are safe. Also, procedure rooms are typically well stocked with all appropriate supplies.

2. Wake the child up
NEVER try to insert an IV (or do any other procedure) in a patient that is not awake. Obviously if the patient is not arousable for a medical reason it’s a different. Being awoken by the pain of a needle can be extremely frightening.

3. Make the parents wait outside
It’s will help eliminate unwanted stress. Parents are very anxious about procedures. They will hover over you. They will be disruptive. Sometimes they faint at the sight of blood which is VERY distracting.

4. Adjust the bed/chair to your level
Be sure you are in a comfortable position. If the bed is too low, raise it up. If its too high, lower it. Make your job as easy as possible.

5. “Do or do not. There is no try.”
Don’t walk in and announce to everybody you are going to try and get an IV. Walk in and announce that you place an IV. Mindset is important. Not only for the parents, but for you as we’ll.

6. Have all equipment ready to go
Make sure you have all appropriate items set up and easy to go. Tubing, flushes, tape, IV board, dressings, etc. Also, don’t bring a lifetime supply of crap. You are placing ONE IV, not 20. If you walk in with 15 angiocaths and 20 alcohol swabs it LOOKS like you have no clue what you’re about to do.

7. Check everywhere and find the best option
Never walk into a room with a predetermined notion of where you’re going to place an IV. Don’t just place an IV in the right antecub because that’s the side the pump is on. Look everywhere and find the best vein you can.

8. The needle is longer than the catheter
This is an important piece of information to remember. When you see blood flash back it means the blood has entered the vein. The catheter is a few millimeters behind the tip of the needle. If you stop advancing the needle to suddenly, the catheter might not be in the vein.

9. Security is everything
Secure your IV well, but in a way that allows nursing to periodically evaluate the side for infiltration.

10. 3 Strikes an you’re out
If you miss 3 times, get help. Obviously, if you are the attending physician at the top of the totem pole, you get more tries.

11. Going blind
“Going blind” is when you attempt the IV placement despite not seeing/feeling a vein. As a resident, this is generally not advised. If you must go blind, don’t announce it to familial observers (which we’ve already discussed should be waiting in the hallway).