Which restraint is most appropriate for the insertion of an IV line in a scalp vein of an infant?
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Overview Show BackgroundVascular access is an important, sometimes critical, step in the care of sick infants and children. Peripheral vascular catheterization provides a direct route for administration of fluids and medications. Many anatomic sites are available for intravenous (IV) catheterization, with peripheral sites being the most common and most readily available. For more information, see Vascular Access in Children. Placing an IV line into a peripheral vein in a small child or infant can be a difficult task, for many reasons. Small children and infants have smaller peripheral veins, they may have more subcutaneous fat, they are prone to vasoconstriction, and they are much less likely to remain motionless and cooperative during a painful procedure than adults. The scalp veins provide a secondary option for peripheral intravascular access in small children and infants by virtue of the minimal subcutaneous fat, the reduced movement, and the lack of a flexible joint; these factors reduce the likelihood of catheter dislodgment, which is common with IV catheters placed in the arms or legs. Indications and ContraindicationsScalp vein catheterization is indicated in any patient who requires intravascular access for the administration of fluids or medications. The decision to attempt access via one of the scalp veins should be based on inspection or palpation of various sites. Although the scalp veins provide certain advantages, the best site at which to attempt access is whichever vein the clinician feels offers the greatest chance for successful catheterization on the basis of his or her ability to visualize or palpate the vessel. Using scalp veins can also help preserve the vessels of the arms and legs for peripherally inserted central catheters (PICCs). [1] Scalp vein catheterization is often considered only after attempts to insert a catheter at other peripheral sites have failed. Attempting IV access near sites of superficial skin injury or infection should be avoided. [2]
 Author Ethan Bergvall, MD Chief Resident, Department of Pediatrics, Tripler Army Medical Center Ethan Bergvall, MD is a member of the following medical societies: American Academy of Pediatrics Disclosure: Nothing to disclose. Coauthor(s) Taylor L Sawyer, DO, MEd, MBA Professor of Pediatrics, University of Washington School of Medicine Taylor L Sawyer, DO, MEd, MBA is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Medical Association, American Osteopathic Association, Association of American Medical Colleges, International Pediatric Simulation Society, Society for Simulation in Healthcare Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Laurie Scudder, DNP, NP Nurse Planner, Medscape; Senior Clinical Professor of Nursing, George Washington University Disclosure: Nothing to disclose. Chief Editor Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Integrated Vascular Surgery Residency and Fellowship, Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of the University of Southern California Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society Disclosure: Nothing to disclose. Acknowledgements The authors wish to thank the skilled nurses of the neonatal and pediatric intensive care units at Tripler Army Medical Center who make so many things possible. The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
How do you secure a scalp IV?Use the thumb of the nondominant hand to secure the vein distally to the insertion site to prevent movement of the vessel. Hold the intravenous (IV) needle and catheter in the dominant hand, parallel to the vessel, pointing in the direction of blood flow.
When giving intravenous fluids in infants which site is most appropriate puncture site?Hand. This can be a great spot. Most infants have at least one vein running up the middle of their hand. The hand is often the best site for transillumination.
Which way does a scalp IV go?Elastic band is used as tourniquet to distend scalp veins. Small piece of tape attached to elastic facilitates removal. Catheter-over-needle device is inserted at 30-degree angle to skin surface, with needle pointing in direction of blood flow; flash of blood is seen in hub as needle enters lumen of vein.
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