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.