Pediatric Intravenous Cannulation Periprocedural Care

Updated: Sep 18, 2017
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vincent Lopez Rowe, MD  more...
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Periprocedural Care

Patient Education and Consent

Explain the procedure to the patient and/or the patient’s representative, and obtain verbal consent.

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Equipment

This topic describes the use of the over-the-needle type of intravenous (IV) catheter, in which the catheter is mounted on the needle (see the first image below). Such devices are available in various gauges (16-24 gauge), lengths (25-45 mm), compositions, and designs (see the second image below).

Various sizes of over-the-needle IV catheters. Various sizes of over-the-needle IV catheters.
Over-the-needle IV catheter. Over-the-needle IV catheter.

In general, the smallest gauge of catheter should be selected for the prescribed therapy, with the aims of preventing damage to the vessel intima and ensuring adequate blood flow around the catheter so as to reduce the risk of phlebitis. [4]

Necessary equipment includes the following (see the images below):

  • Nonsterile gloves
  • Tourniquet
  • Antiseptic solution (2% chlorhexidine in 70% isopropyl alcohol)
  • Local anesthetic solution
  • 1-mL syringe with a 30-gauge needle
  • 2 × 2 gauze
  • Venous access device
  • Vacuum collection tubes and adaptor
  • Saline or heparin lock
  • Saline or heparin solution
  • Transparent dressing
  • Paper tape
  • Padded arm board
  • 1/2-in. gauze bandage roll
Partial selection of equipment required for pediat Partial selection of equipment required for pediatric IV cannulation.
Partial selection of equipment required for pediat Partial selection of equipment required for pediatric IV cannulation.

The patient’s skin should be washed with soap and water if it is visibly dirty.

Because infants and young children are unlikely to cooperate, it is recommended that an assistant aid in stabilizing the extremity during the procedure.

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Patient Preparation

Anesthesia

Both intradermal injection of a topical anesthetic agent just prior to IV insertion and topical application of a local anesthetic cream about 30 minutes prior to IV insertion have been shown to significantly reduce the pain associated with IV catheterization. One or the other should be used unless the situation is an emergency. [5, 6, 7]

Positioning

Make sure that there is adequate light and that the room is warm enough to encourage vasodilation. Adjust the height or position of the bed or chair to make sure that you are comfortable and to prevent unnecessary bending. Make sure that the patient is in a comfortable position, and place a pillow or a rolled towel under the patient’s extended arm.

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