IV insertion in children

Trainee : During my last training, one of the most intimidating tasks was IV insertion. It was one of the most traumatic experiences for a child.

Nurse : Sure ! A painless venipuncture is almost impossible, but that doesn’t mean it’s not possible to make it a sort of playful experience for the child.

Trainee : But how can this be done ?

Nurse : There are some practical and communication techniques for that. For example, you should first determine the child’s developmental age, that’s because of the IV insertion site, the size of the catheter, and therefore the way health information or instruction will be disclosed to the child.

Trainee : What sort of information can be given to the child and his family on the IV line ?

Nurse : Painful procedures must be done outside the patient’s room so that the child does not associate pain with the room where he is being cared for. We have to use an appropriate tourniquet and make sure it’s not too tight and for not too long.

Trainee : Are there any technical recommendations that one should know ?

Nurse : Yes. Choosing age-appropriate IV sites, for example the hands and feets, instead of the antecubital, or the forearm or upper arm, and the non-dominant hand to allow thumb sucking, which favors relaxation, proves to be a good idea. And of course the nurse should choose the smallest-gauge catheter, in the shortest length, to allow hemodilution of infusates by blood flow around the catheter. And then, of course, protect the IV site to prevent dislodgement.

Trainee : But a painless IV insertion is impossible, and we’re always told never to mention anything that indicates pain, I mean this is all confusing !

Nurse : Sure ! But one of the worst communication techniques for children is to give false assurance. The younger the child, the less amount of information you have to give before the procedure. Never tell a young patient that venipuncture won’t hurt or will be fast when it’s actually not. Be honest and try to use a logical way to set the patient’s expectations.

Trainee : Therefore, I guess there might be other communication techniques to use !

Nurse : Oh yes, alternative techniques like the « hug technique », with the help of the parents, provide emotional support to the child. We also use forms of distraction such as letting the patient blow bubbles, sing or count as the procedure progresses. You can use iPads as a distraction tool, but also for preparing patients and families for the procedure to come or for telling the patient that he can play during an IV insertion. The presence of a parent is a major support that can reduce anxiety.

Trainee : Now I see that IV insertion in pediatric patients can be quite challenging especially for the newbies but with the right practice and mastery, it will never be out of reach anymore. Nursing is an art, so we have to make every procedure a pleasant experience for us and the patients that we care for.