IV THERAPY

Obtaining Venous Access

• Needle size depends on: Solution and Rate at which it will be administered

• Commonly used needle sizes include 22-gauge, 24 gauge, and 25 gauge (in newborns)

• “Butterfly” needles are metal needles with a flange of plastic added on both sides of the needle
hub to give the person starting the infusion a wider surface to grasp, thereby making it easier to
guide needle placement. Butterflies are also termed “scalp vein needles” because they were
originally designed for use in infant scalp veins

• A length of narrow tubing leads from the needle to the fluid administration tubing. This tubing
must be flushed with IV solution before the needle is inserted to avoid an air embolus

Frequently used sites for IV insertion:

• Veins on the dorsal surface of the hand or on the flexor surface of the wrist

• Leg and foot veins

• Scalp Vein over the temporal area

Reminder: An infusion placed in a scalp vein can be frightening to parents because it seems a much
more serious procedure than an infusion administered into a hand. Explain to parents that scalp vein
infusion is an effective method of administering fluid or medicine to infants and ultimately might cause
the least discomfort for their child because needles

Preschoolers and Older Children

• Preschoolers and older children often express a preference regarding where they want an
infusion inserted. Offer a choice, if possible, or suggest the nondominant hand. Act as the child’s
advocate and see that wishes are respected.

• Children who have IV infusions for long periods may require the placement of an intracath (a
slim, pliable catheter threaded into a vein).

Rationale: It cannot be dislodged as easily as a normally inserted IV needle, allowing a child to move
about more freely.

Safety Measures for a Pediatric Patient with an IV Line

• For all children (including adolescents), IV infusions are usually secured in place with at least a
small arm board. Although children may say they will be careful not to move their arms, without
an arm board it is easy to move unintentionally to turn off the television set or reach for
something that fell off the bed and accidentally dislodge the needle.

• Tape a board to the arm of an older child with the words, “This is just to remind you to keep
your arm still”—an explanation more acceptable than if children think you doubt their ability to
hold their hands still.