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  • • Vascular access in nonemergent situations or temporary access in emergent situations.

    • Administration of fluids and electrolytes.

    • Administration of intravenous medications.

    • Administration of blood and blood products.

    • Blood sampling.

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Absolute

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  • • Do not insert through an infected site.

    • Do not insert through a burn.

    • Do not insert in an injured site.

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Relative

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  • • Avoid a paralyzed extremity.

    • Do not insert in a massively edematous extremity.

    • Do not insert an IV distal to injured organs (eg, do not use lower extremities when treating abdominal injuries).

    • Avoid joint area.

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• Caution: All equipment must be latex free.
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  • • Gloves.

    • Tourniquet or rubber band.

    • Tape and occlusive transparent dressing.

    • Alcohol wipes.

    • Povidone or chlorhexidine.

    • Syringe filled with injectable saline.

    • Gauze pads.

    • IV device: catheter or butterfly of appropriate size to fit the patient and the task.

    • Topical anesthetic cream.

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  • • Ultrasound guiding equipment (if available and if trained in its use).

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  • • Infection.

    • Hematoma.

    • Extravasation.

    • Compartment syndrome.

    • Severe vasoconstriction if vasoactive medications are infused through a peripheral IV and extravasate.

    • Venous thrombosis.

    • Embolization of air or catheter fragment.

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  • • Plan the procedure.

    • Limit the procedure time.

    • Have a backup plan.

    • Examine all possible sites carefully before choosing one.

    • Apply gentle circumferential pressure with 1 hand on the extremity to fill up the veins, which helps identify the most appropriate site.

    • In choosing the equipment and the site for the line, consider the patient’s needs.

    • • A trauma patient will require a large bore line, preferably a short one in order to avoid high resistance with high flows.

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  • • Introduce yourself to the parents and to the patient.

    • Explain to the parents and the child, if appropriate, the procedure and its purpose.

    • Choose 1 or more possible sites, and apply topical anesthetic cream.

    • Answer all of the parents’ and patient’s questions.

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  • • Position the patient with the chosen site closest to you.

    • Have a helper gently restrain and distract the child.

    • Have the patient at a comfortable working height.

    • For external jugular line placement, have the patient’s head lower than the trunk (Trendelenburg).

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  • • Accessible peripheral veins that are usually available include the following (Figure 8–1):

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    • • On the dorsum of the hands.

      • On the radial side of the hand.

      • In the antecubital fossa.

      • The saphenous vein at the medial aspect of the ankle.

      • The dorsum of the feet.

      • External jugular vein.

    • In infants, additional sites include scalp veins.

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