Overview
Pediatric IV Access is a fundamental procedure for establishing vascular access in children for fluid administration, medication delivery, and blood sampling. This procedure requires specific techniques adapted for pediatric anatomy and physiology.
IV access is essential for emergency care, fluid resuscitation, medication administration, and blood sampling in pediatric patients. Proper technique is crucial as pediatric veins are smaller and more fragile than adult veins.
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Indications
Dehydration, shock, maintenance fluids
Emergency medications, antibiotics, pain control
Laboratory testing, blood cultures
Critical illness, trauma, resuscitation
Preoperative fluid administration
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes selecting appropriate IV catheter size, gathering necessary equipment, ensuring proper patient positioning and restraint, and preparing the insertion site. All team members should understand their roles.Step-by-Step Procedure
Step 1: Site Selection
Select appropriate vein (hand, forearm, antecubital). Avoid areas with infection, thrombosis, or previous failed attempts. Consider patient comfort and indication.
⚠️ Common Mistakes to Avoid:
- Poor site selection
- Choosing infected site
- Ignoring patient preference
💡 Pro Tip:
Start distally and work proximally to preserve veins for future access.
Step 2: Patient Preparation
Explain procedure to patient and family. Position patient comfortably. Apply tourniquet proximal to site. Clean area with antiseptic solution.
⚠️ Common Mistakes to Avoid:
- Inadequate explanation
- Poor positioning
- Insufficient cleaning
💡 Pro Tip:
Use age-appropriate language and involve parents in the process.
Step 3: Vein Visualization
Use transillumination, warm compress, or gravity to enhance vein visibility. Palpate vein to confirm location and patency.
⚠️ Common Mistakes to Avoid:
- Poor vein visualization
- Not palpating vein
- Rushing the process
💡 Pro Tip:
Use transillumination for difficult-to-visualize veins in young children.
Step 4: Catheter Insertion
Insert catheter at 15-30 degree angle. Advance until blood return is seen. Thread catheter into vein. Remove needle and secure catheter.
⚠️ Common Mistakes to Avoid:
- Wrong insertion angle
- Inadequate advancement
- Poor catheter threading
💡 Pro Tip:
Use a shallow angle for pediatric veins to avoid through-and-through puncture.
Step 5: Confirmation and Securing
Confirm blood return. Flush with saline. Secure catheter with tape or commercial device. Document insertion details.
⚠️ Common Mistakes to Avoid:
- Failure to confirm placement
- Poor securing technique
- Inadequate documentation
💡 Pro Tip:
Always flush with saline to confirm proper placement and patency.
Step 6: Post-Insertion Care
Monitor for complications. Assess site regularly. Change dressing as needed. Document any issues.
⚠️ Common Mistakes to Avoid:
- Inadequate monitoring
- Poor site care
- Failure to document
💡 Pro Tip:
Regular assessment of the IV site prevents complications.
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Post-procedure Care
Post-insertion care involves securing the IV catheter, confirming proper placement, monitoring for complications, and documenting the procedure. Regular assessment of the IV site is essential.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Infiltration | 10-20% | Swelling, pain, coolness at site | Remove catheter, apply warm compress | Proper technique, regular assessment |
| Phlebitis | 5-15% | Redness, warmth, pain along vein | Remove catheter, warm compress | Proper aseptic technique |
| Infection | 1-5% | Redness, warmth, purulent discharge | Remove catheter, culture if needed | Strict aseptic technique |
| Hematoma | 5-10% | Bruising, swelling at site | Pressure, ice, monitor | Proper technique, adequate pressure |
Clinical Pearls
Start distally and work proximally to preserve veins for future access.
Use age-appropriate language and involve parents in the process.
Use transillumination for difficult-to-visualize veins in young children.
Use a shallow angle for pediatric veins to avoid through-and-through puncture.
Always flush with saline to confirm proper placement and patency.
Regular assessment of the IV site prevents complications.
Use appropriate catheter size - smaller is not always better.