02.07 Tips & Advice for Pediatric IV

Hey guys, my name is Ashley and I've been a pediatric nurse for 14 years. And in this video I'm just going to walk you through some tips and tricks for how to place an iv in a child.  I can still remember every detail of the first iv that I've put in a baby.It was a form of fold and I honestly thought I was gonna pass out. I was so nervous. But you know what, I had a really great mentor and she gave me some great tips and I got it in on the first try. And that's what I'm hoping for you as well after you watch this video. So let's get started. So the first thing to keep in mind when it comes to the actual process of placing an iv in a child is that the steps you're going to take are actually pretty much the same as you would use for an adult. 

What's different though are the extra things, the pre-planning that you need to do to set yourself up for success. So that's what I'm going to go through here in this video is some of these things to think about ahead of time. The first thing you want to do is find out exactly how old the child is. And then it's probably also really helpful to go chat to the parents and find out how they usually tolerate medical things like this, how they've tolerated immunizations, things like that. Toddlers and preschoolers are typically the most difficult to put an IV in. But honestly, I've had older children, seven, eight, nine-year-old vestry in the place down and kick. And then I'm also had three-year-olds that actually commonly sit and watch the whole thing. So your best information is going to be from the parents.

The second thing you want to do is make sure that you have help. This is at least a two person job. You definitely going to need someone there to help with positioning and then it's probably also going to be really helpful for you to have someone there that can hand you supplies. So definitely grab another nurse. And if you're lucky enough to have a child life specialist on your team, get their help as well. The third thing you need to do, it takes some time to get your supplies. You want to make sure that you take everything that you need with you, that you have everything right there next to you ready to go. And that you don't have to stop and go looking for something in the middle of the process. And you also want to make sure that you take extra, that you've got extra supplies on hand. 

Kids who are fighting and screaming, we're going to be sweating. Okay? So that skin is going to get sweaty and we all know that tape and occlusive dressings are not going to stick to that sweaty skin. So bring some gauze and bring some extra things to help you readdress the iv. It's the first time first attempt doesn't work. You also want to be prepared with a way to secure that iv for the child in the sense of like an arm board or maybe some gauze to wrap around the iv to help protect it. Remember kids are going to be active, you're going to be moving around and playing. So we wanna make sure that we protect it so that we can keep it for longer than a day. Now when it comes to choosing the right candle, other are really two different sizes that you're primarily going to be using. 

This first size is the 24 gauge, which is your yellow canula and that's primarily going to be for infants and young toddlers. The second one that you have is your blue canula, which is the 22 gauge, and that's going to be for uh, preschoolers, older children. And then when you get to the adolescent age, you're probably going to be choosing the same type of equipment and size canula that you would for your adult patients. And the very last thing that I want you to do is just have a complete and total plan for how this whole process is going to unfold. There's actually quite a lot to think about here, but it's all pretty simple. So let's talk through the things you need to think about ahead of time. So the first thing you want to do is find out and think about who's going to be with the child during the procedure. 

You should have a caregiver, a parent, a sibling, someone that's comforting to them and can help in the process with them for the procedure. The second thing you want to think about is where are we going to do this? So most of the time we like to take children to the treatment room. The treatment room just makes sure that their, their actual room stays a safe place for them. But sometimes parents prefer to use their rooms. So just check with the parents. But we do encourage using the treatment room. Next you want to think about what comfort measures might be beneficial. So if they're younger, you might want to think about having a pacifier on hand. They might be more comfortable sitting in their parents' lap. Do they have a favorite toy or a favorite blanket? All those things are gonna help this process go more smoothly and kind of alongside of comfort. 

We want to think about positioning in what position is this child going to feel the most safe and secure. Now a lot of times the tendency is to lie the child flat and sort of hold them down. This is the most this, this position is going to cause more anxiety than any other position cause the child feels completely out of control. So try other positions first if he can. So have him sit up, see if they'll hold the limb still for you or they can sit in their parent's lap. And last but not least, you want to think about how are we going to distract this child? So what tools do we have on hand? The parents may want to tell them a story or sing a song during the process. They may have a book or a lot of times children watch cartoons while we put in the, the iv. 

So just have a think about what's going to distract. Cause that's the single best way to keep their mind off what's happening and to keep them still. So once you've answered these questions, you're ready to go. You've got what you need, you have a plan, you're ready to go approach the child. So I just want to give you a couple tips about the actual process or the act of putting the iv in. So the first thing you want to remember is to make sure that you're really patient and take your time with locating a good site. There's a tendency when you've got an anxious child in front of you to really want to rush the process. But don't do that. You really want to be confident in that vein that you choose. So make sure you take a few minutes to really, really locate the best possible site that's going to give you the best chance of being accurate on that. 

First try. A couple of things to remember. If you're looking at sites, the hands are great, they work for any age child. Just be mindful of using the dominant hand or maybe if they suck their thumb, you might want to avoid that hand as well. Feet work really well for younger patients. But the main thing to think about there as you want to try to only use speak on non-mobile patients and to juveniles are really popular because they're always easy to find. But again, as we talked about earlier, when we think about securing the iv children are very active. They're going to be playing and moving around. So antiquated rules can be really difficult to maintain. Okay. So once you've located that perfect vein and you're ready to go one thing to keep in mind is the way and what you're going to say and how you're communicating with the child. 

One thing that's really helpful is to tell them that they have a job to do and that their job while you're doing this is to keep that hand as still as possible. Tell them they can be loud. They can scream, but they have to keep that hand really still. Another really important thing with communication is to make sure that you don't say that you're finished until all hands are off the patient and the process is completely over. So that's really, really important so that they can trust what you're saying. Okay guys, that's it for my tips and tricks and tricks for placing an iv. I wish you the best of luck with everything and happy nursing.