Starting an IV intravenous drip

Most pediatric hospitals have teams of technicians who specialize in starting IVs and drawing blood. The IV technician will generally use a vein in the lower arm or hand. First, a constricting band is put above the site to make the veins larger and easier to see and feel. The vein is felt by the technician, the area is cleaned, and the needle is inserted. Sometimes a needle is left in place and sometimes it is withdrawn, leaving only a thin plastic tube in the vein. The technician will make sure that the needle (or tube) is in the proper place, then cover the site with a clear dressing and secure it with tape.

Some methods that help when having an IV started are:

• Stay calm. The body reacts to fear by constricting the blood vessels near the skin surface. Small children are usually more calm with a parent present; teenagers may or may not desire privacy. Listening to music, visualizing a tranquil scene (mountains covered with snow, floating in a pool), or using the same technician each time can help.

• Use EMLA cream or Numby Stuff. EMLA—a cream anesthetic—is applied to the skin one to two hours prior to the procedure to prevent pain. In some cases, it can constrict the veins, so experiment to see if it works for your child. Numby Stuff—a needle-free anesthetic—delivers a cream anesthetic through the skin using a mild, low-level electric current. EMLA cream and Numby Stuff are not recommended when giving medications (for example, vincristine) that can burn the skin if leakage occurs.

• Keep warm. Cold temperatures also cause the surface blood vessels to constrict. Wrapping the child in a blanket and putting a hot water bottle on the arm can enlarge the veins.

• Drink lots of fluids. Dehydration decreases the fluid in the veins, so encourage lots of drinking.

• Let gravity help. If the child is lying in bed, have her hang her arm down over the side to increase the size of the vessels in the arm and hand.

• Let your child have control as appropriate. If your child has a preference, let him pick the arm to be stuck. If he is a veteran of many IVs, let him point out the best vein. Good technicians know that patients are quite aware of their best bet for a good vein.

• Stop if problems develop. The art of treating children requires lots of time on preparation and not much time on procedures. If a conflict arises, take a time-out and regroup. Children can be remarkably cooperative if their needs are respected and they are given some control over the situation.

You'll think I'm crazy, but I'll tell you this story anyway. After getting stuck constantly for a year, my daughter (5 years old) just lost it one day when she needed an IV. She started screaming and crying, just flew into a rage. I told the tech, "Let's just let her calm down. Why don't you stick me for a change?" She was a sport and started a line in my arm. I told my daughter that I had forgotten how much it hurt and I could understand why she was upset. I told her to let us know when she was ready. She just walked over and held out her arm.

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