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

 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

Tips on Starting I.V.s

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.