Background
Pediatric intravenous (IV) cannulation is an integral part of modern medicine and is practiced in virtually every healthcare setting. Venous access allows the sampling of blood, as well as administration of fluids, medications, parenteral nutrition, chemotherapy, and blood products. [1]
This topic describes the placement of an IV catheter in an upper extremity of a pediatric patient. A similar technique can be used for placement of IV catheters at different anatomic sites.
Indications
Indications for pediatric IV cannulation include the following:
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Repeated blood sampling
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IV fluid administration
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IV medication administration
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IV chemotherapy administration
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IV nutritional support
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IV blood or blood products administration
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IV administration of radiologic contrast agents (eg, for computed tomography [CT], magnetic resonance imaging [MRI], or nuclear imaging)
Contraindications
No absolute contraindications exist for pediatric IV cannulation.
Peripheral venous access in an injured, infected, or burned extremity should be avoided if possible.
Vesicant solutions can cause blistering and tissue necrosis if they leak into the tissue. Irritant solutions (pH < 5, pH >9, or osmolarity >600 mOsm/L, including sclerosing solutions, some chemotherapeutic agents, and vasopressors) also are more safely infused into a central vein. Therefore, these solutions should only be given through a peripheral vein in emergency situations or when central venous access is not readily available.
Technical Considerations
Best practices
In an emergency situation or when patients are expected to require large volumes infused over a short period of time, the largest-gauge and shortest catheter that is likely to fit the chosen vein should be used. The catheter chosen should always be slightly smaller than the vein.
Veins have a three-layered wall composed of an internal endothelium surrounded by a thin layer of muscle fibers, which is surrounded by a layer of connective tissue. Venous valves encourage unidirectional flow of blood, prevent pooling of blood in the dependent portions of the extremities, and can impede the passage of a catheter through and into a vein. Venous valves are more numerous just distal to the points where tributaries join larger veins and in the lower extremities. [2]
Veins with high internal pressure become engorged and are easier to access. The use of venous tourniquets, dependent positioning, pumping via muscle contraction, and the local application of heat or nitroglycerin ointment can contribute to venous engorgement. [2]
The superficial veins of the upper extremities are preferred to those of the lower extremities for peripheral venous access because they interfere less with patient mobility and pose a lower risk for phlebitis. [3] It is easier to insert a venous catheter where two tributaries merge and form a Y shape. It also is recommended to choose a straight portion of a vein to minimize the chance of hitting valves.
The scalp veins are easily accessed in infants. They can be engorged by placing a rubber band around the patient’s head at the forehead level.
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Various sizes of over-the-needle IV catheters.
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Over-the-needle IV catheter.
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Partial selection of equipment required for pediatric IV cannulation.
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Partial selection of equipment required for pediatric IV cannulation.
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Vein palpation for pediatric IV cannulation.
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Application of antiseptic solution for pediatric IV cannulation.
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Angle of insertion with bevel up for pediatric IV cannulation.
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Flashback of blood into venous access device for pediatric IV cannulation.
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Sliding hub of catheter over needle and into vein in pediatric IV cannulation.
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Securing venous access device in place using transparent dressing in pediatric IV cannulation.
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Using nondominant hand to secure venous access device in vein, while using dominant hand to remove and secure needle.
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Blood sampling in pediatric IV cannulation.
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Flushing venous access device in pediatric IV cannulation.
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Securing pediatric venous access device.
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Securing pediatric venous access device.
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Securing pediatric venous access device.
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Pediatric IV cannulation. Video courtesy of Gil Z Shlamovitz, MD.
