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  1. Indications

      1. Administration of intravenous (IV) medications and fluids.

      1. Administration of parenteral nutrition.

      1. Administration of blood and blood products.

      1. Emergency vascular access.

  2. Equipment. Armboard, adhesive tape, a tourniquet, alcohol swabs, normal saline for flush (1/2 normal saline if concerned about hypernatremia), povidone-iodine solution, a needle (a 23- or 25-gauge scalp vein needle or a 22-to 24-gauge catheter-over-needle; self-shielding safety types preferred; at least a 24-gauge for blood transfusion); transparent dressing material; appropriate IV fluid and connecting tubing.

  3. Procedure

      1. Scalp vein needle

          1. Select the vein to use. Neonatal sites are shown in Figure 37–1. It is useful to select the "Y" or crotch region of the vein, where two veins join together for the insertion.

              1. Scalp. Supratrochlear, superficial temporal, or posterior auricular vein.

              1. Back of the hand. Dorsal arch vein.

              1. Forearm. Median antebrachial or accessory cephalic vein.

              1. Foot. Dorsal arch vein.

              1. Antecubital fossa. Basilic or cubital vein.

              1. Ankle. Greater saphenous vein.

          1. Shave the area if a scalp vein is to be used.

          1. Restrain the extremity on an armboard, or have an assistant help hold the extremity or the head.

          1. Apply a tourniquet proximal to the puncture site. If a scalp vein is to be used, a rubber band can be placed around the head, just above the eyebrows.

          1. Clean the area with povidone-iodine solution, allow to dry, and wipe off with sterile water or saline.

          1. Fill the tubing with flush and detach the syringe from the needle.

          1. Grasp the plastic wings and, using your free index finger, pull the skin taut to help stabilize the vein.

          1. Insert the needle through the skin in the direction of the blood flow and advance ~0.5 cm before entry into the side of the vessel. Alternatively, the vessel can be entered directly after puncture of the skin, but this often results in the vessel's being punctured "through and through" (Figure 37–2).

          1. Advance the needle until blood appears in the tubing.

          1. Gently inject some of the flush to ensure patency and proper positioning of the needle.

          1. Connect the IV tubing and fluid, and tape the needle into position.

      1. Catheter-over-needle assembly

          1. Follow steps 1–5 for the scalp vein needle.

          1. Fill the needle and the hub with flush via syringe; then remove the syringe.

          1. Pull the skin taut to stabilize the vein.

          1. Puncture the skin, then enter the side of the vein in a separate motion. Alternately, the skin and the vein can be entered in one motion.

          1. Carefully advance the needle until blood appears in the hub.

          1. Withdraw the needle while advancing the catheter.

          1. Remove the tourniquet, and gently inject some normal saline into the catheter to verify patency and position.

          1. Connect the IV tubing and fluid, and tape securely in place using transparent dressing.

  4. Complications

      1. Hematoma (most common complication) at the site can often be managed effectively by gentle manual pressure and is the most common complication.

      1. Phlebitis risk increases the longer a catheter is left in place, especially if >72 h. Heparinized solutions may decrease ...

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