When a child needs peripheral I.V. therapy

Nursing, Apr 1998 by Frey, Anne Marie

USE THEME SUGGESTIONS TO CHOOSE THE RIGHT SITE.

ALTHOUGH YOU MAY BE CONFIDENT when choosing an appropriate I.V. site in an adult, you may not be so sure of yourself when the patient is a child. Because a child has more subcutaneous tissue covering his veins than an adult, examining his veins is difficult. Knowing a child's vein anatomy will make palpating for veins and documenting the location of an I.V. site easier.

The choice of I.V. site depends on the type and duration of I.V. therapy as well as the child's developmental level. For example, you might choose to use a scalp vein in a neonate because this site is easy to access and highly visible. An older infant might dislodge an I.V. device placed in the scalp, so the hand or foot may be a better choice. A hand site may be used in children of all ages but is more painful than other sites because nerve endings are close to the skin surface.

If the infant or toddler sucks his thumb, place the I.V. device in the opposite hand. Use the nondominant hand in a preschool or school-age child, as you would in an adult.

Adolescents, who may be concerned with body image, may wish to have the I.V. device placed in a less conspicuous site, such as the forearm or upper arm. Allowing the patient to choose the site also gives him a degree of control over his care.

A forearm site keeps the patient's hands free and can accommodate larger-sized catheters. This site is suitable for all pediatric patients, but you may have difficulty visualizing veins in chubby toddlers.

Inserting the I.V. device into an antecubital site (cephalic, basilic, or median cubital vein) is appropriate for children of all ages, and these veins are easy to locate in infants. However, a device inserted here limits activity and must be supported by an armboard.

Digital veins may be used in patients from toddler to adolescent age. These finger sites are useful if other sites are inaccessible, but they infiltrate easily.

The Centers for Disease Control and Prevention has no specific recommendations for I.V. site changes in children; research indicates that an I.V. device may be left in place up to 144 hours (6 days). Beyond this, the risk of infection increases. Adult I.V. sites are changed every 48 to 72 hours because of the risk of phlebitis, a complication rarely seen in children. If a child has limited venous access, the I.V. site isn't routinely rotated.

The average duration for a peripheral access is 2 to 3 days. If the child is to receive I.V. therapy for more than a week, or if hypertonic solutions are ordered, an intermediate- to long-term central catheter is a better choice.

BY ANNE MARIE FREY, RN, CRNI, BSN

Clinical Nurse, Level IV I.V. Team The Children's Hospital of Philadelphia, Pa.