Background
Vascular 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 Contraindications
Scalp 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]
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Common sites of insertion for peripheral scalp vein catheterization include frontal, posterior auricular, and superficial temporal veins.
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Elastic band is used as tourniquet to distend scalp veins. Small piece of tape attached to elastic facilitates removal.
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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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Once needle has entered vein, catheter-over-needle device is (1) lowered so that it is just off skin surface, then (2) advanced slightly further to ensure that both needle tip and catheter tip are in vessel lumen.
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When both needle tip and catheter tip are inside vessel lumen, catheter is advanced forward (1) off needle and further into vein.
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IV extension tubing (preflushed with normal saline) is attached to catheter after removal of needle. Saline-filled syringe is used to gently flush catheter while observing for signs of infiltration.
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Catheter is secured with clear plastic dressing. Folded piece of 2 × 2 cm gauze is used to protect skin from hard plastic of catheter hub and extension tubing connector.
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Extension tubing is secured with tape to prevent inadvertent removal of catheter.
