Peripheral Intravenous

Access
Indications
• Fluids
• Medications
• Nutrition
• Blood and blood products
Setting and Equipment
• Whenever possible, procedures should
be performed AWAY from the bedside
(i.e. in treatment rooms)
• Get helpers - you will need at least one
other staff-member
• Adequate lighting
Setting and Equipment
Have equipment ready before the child enters the
room:
- Armboard
- Adhesive tape
- Tourniquet
- Alcohol swabs
- Gauze pad
- Clean gloves
- Normal saline for flush
- Intravenous catheter
- 23-25 gauge scalp vein needle or 22-24 gauge catheter-over-needle
- Appropriate IV fluid and connecting tubing
Placement
Sites

- Scalp
- Dorsum of the
hand
- Forearm
- Foot
- Antecubital
fossa
- Ankle
 Techniques
Step 1: Select the vein
Step 2: Restrain the
extremity.
Step 3: Pain Management*
Step 4: Apply tourniquet
proximal to the puncture
site.
Step 5: Clean the area
Step 6: Insert the needle
through the skin in the
direction of blood flow.
 Techniques

Angle Variation
a. Small and superficial
b. Very deep
c. Very small and
superficial
 Techniques
Step 7: Advance the
needle when blood
appears in the flash
chamber/tubing.
Step 8: Remove
tourniquet
Step 9:Connect the IV
fluid and tubing and
tape the needle into
position.
Scalp Vein Catheterization
• The scalp veins provide a secondary
option for peripheral intravascular access
in small children and infants because of
minimal subcutaneous fat and less
movement and the lack of a flexible joint.
• Is often considered only after attempts to
insert a catheter at other peripheral sites
have failed.
• Help preserve the vessels of the arms and
legs for peripherally inserted central
catheters.
Positioning
• The patient should be lying in a supine
position with his or her head turned so
that the desired scalp vein is visible and
readily accessible.
• The clinician should be located at the
head of the bed with the patient’s feet
extending away from the clinician
• A slight head-down position may
facilitate catheterization by distending
the veins of the head and neck
Techniques

Step 1. Locate the

frontal, superficial
temporal, or
posterior auricular
vein in the scalp.
Step 2. Shave the
preferred site
 Techniques

Step 3. Place an elastic

band around the
patient’s head or
occlude the vein
proximally with the
index finger of the
nondominant hand.
 Techniques

Step 4. Clean the site of

insertion thoroughly
with antiseptic wipes.
Step 5. Insert the needle
into the vein, angled
20-30º off the skin
surface.
 Techniques

Step 6. Attach
extension tubing
preflushed with
saline and a saline-
filled syringe . Gently
inject saline solution
into the catheter,
and observe for any
infiltration into
surrounding tissues.
Techniques

Step 7. Secure the

catheter in place
with a clear, sterile
adhesive dressing .
References
• Tintinalli et al (2015). Emergency
Medicine A Comprehensive Study
Guide 8th Ed.
• Reichman (2013). Emergency
Medicine Procedures 2nd Ed.
• Gomella et al (2013). Neonatology 7th
Ed.