Pediatric IV Therapy

Amy Mersiovsky, MSN, RN, BC

The Need For IV Therapy

The Need For IVs
The Need For IV Therapy
Arrest Situations

Hypovolemia

Shock

Medication Needs

Safety Points
A 500ml bag of IV fluids should be used for all
pediatric patients

IV fluids should be administered via infusion
pump or buretrol

IV boluses should be given IV Push

Monitor the IV site closely

No chloraprep for cleaning in infants under 2
months old


Selecting the site

Choice of site depends on age,
developmental level, type & duration of
therapy

Children have more subcutaneous tissue
covering the veins - knowing a childs vein
anatomy will make palpating for veins
easier

Use non dominant hand whenever possible
Suitable Sites
Locating a Vein
Apply warm compress to dilate
Press an alcohol wipe several
times along the suspected path
of the vein; alcohol dilates
blood vessels close to surface
Use anatomy: infants &
toddlers vein are often
where their supposed to be
IV SITE GUIDELINES
Scalp newborns infants under 9 months of age

Feet infant of non-walking age

Hand Any age, may be more painful as nerves are
close to skin, however, veins also close to skin and
easier to palpate

Antecubital Any age, may be difficult on infants
and small children related to large amount of SQ
tissue
Scalp Veins
Temporal & frontal veins are the largest and easiest
to locate

Check for a pulse to make sure that the vessel is not
an artery

Determine the direction of blood flow - in the scalp,
arteries fill from below, veins from above

Infant veins are fragile and may rupture from
pressure, may need to use a finger to distend the vein
Scalp Veins
Hand Sites

Good options are the dorsal venous arch or
the cephalic vein - it is a large vein that is
well-secured to the fascia

Digital veins may be used but infiltrate easily
Hand Sites
Hand Sites
Forearm Site

Forearm site keeps patients hands free & can
accommodate larger-sized catheters

Site suitable for all pediatric patients

May have difficulty visualizing veins in chubby
toddlers
Forearm Sites
Antecubital Sites
Antecubital Site

Suitable for all pediatric patients
Veins easy to locate in infants
Limits activity & must be supported by an
armboard
To distinguish vein from tendon: rotate the
forearm while palpating the area - tendon will
roll as you rotate the arm
Feet and Lower Legs
Feet and Lower Legs
Consider mobility problems in child whos walking

Have an assistant immobilize the limb

Consider dorsal arch

Consider great saphenous vein in chubby infant or
toddler
Large and well-secured by connective tissue, making it less
likely to move when needle inserted
Tips on Starting I.V.s
With infants and small children, flashback
may be sluggish or may be only a small drop -
move slowly and be patient
Once flashback is noted, go in slightly
further, but not more than 1/8 of an inch to
avoid piercing the opposite vein wall
If catheter wont advance, try flushing with a
small amount of saline as the catheter is
moved forward
Bevel down
Use appropriate size catheter for the patient
22guage or 24 guage for smaller children
Securing the IV
Clean any blood or fluids from site with alcohol then
dry with gauze
Blood collected at hub site can lead to infection

Apply Chevron tape if able, without dislodging
catheter
Increases stability of dressing

Apply Tegaderm over catheter

If did not apply Chevron apply a piece of tape
across hub to keep Tegaderm from stretching
Armboards and guards
Securing the IV
Securing the IV
Securing the Site

Site Assessment
Assess at least Q 1 hour for signs and
symptoms of infiltration

Assess temperature of the site, as well as
the symmetry of the limbs or scalp

Site should be gently touched to determine
whether it is soft or taut, or whether the
scalp site is boggy
Site Assessment
Assess for swelling above and below the
site

Assess for pain at site

If signs of infiltration occur stop the
infusion immediately, restart or notify
physician to see if IVF therapy may be
dcd

IV Fluids
Most often use Isotonic Crystalloids
0.9% NaCl
Lactated Ringers
IV Fluid boluses are calculated by:
20mlxkg
Take care when administering emergency
Dextrose

IV Documentation
Site location
Name of vein used
Catheter type and size
Number of I.V. placement attempts
Treatment administered
Childs response to treatment
Questions?







Contact HOTRAC at 254-761-7890 for more
information about this presentation.