Infiltrating


I began my pediatrics clinical rotation last week along with Pediatrics and Obstetrics lecture. Thankfully, I was able to get the type of rotation where each student is assigned one preceptor and follows that nurse for an entire 12-hour shift one day per week rather than two shorter days per week. I would rather have one day that is super busy and tiring and one day off than two days that are busy and tiring. I always collapse after clinical, whether it has been 4 hours or 12 hours.

My unit has medical-surgical patients with various GI, neuro, and some renal patients. Basically, a smattering of low-acuity kids who either need to be diagnosed or are coming back for a few maintenance visits/procedures.

Lesson of this week: pediatric IVs.

I had been warned in both clinical orientation and in lecture, pediatric IVs infiltrate fast. FAST. Also, little people do not or are unable to tell you that something is wrong. A nurse must look at an IV site for redness and swelling every hour and before attaching new fluids or medicines, flush a small amount of normal (isotonic) saline so we can see and feel that the catheter is  still in the vein and not poking through into the tissue. Infiltration is a BAD thing with your isotonic fluids, let alone medications.

In my clinical, I was beginning my assessment of an IV in preparing to administer an IV antibiotic that is a known vesicant.* It didn’t have a blood return (not bad) and flushed rather easily. I let my nurse know that there was no blood return, but continued to set things up. My nurse also assessed the site and compared his IV hand with the non-IV hand; some edema was present. She flushed a little more saline through and asked the patient if it hurt.

“Ow, yes!” (Patient is a younger adolescent).

Nurse, “Yeah, we should probably start another IV then.”

Patient: “That’s okay, I’ll just live through it.”

Nope! It doesn’t work like that kid. On pediatric patients, especially those younger than 16, we just call IV team because veins are not as visible the younger the patient. The IV woman came within an hour, used her awesome ultrasound and placed a new IV in the patient so the antibiotic could be given safely.

The experience didn’t scare me, rather helped me see what else goes into an assessment and better techniques for assessing the pediatric IV. Some catheters are tiny; some only need 3 cells to occlude and clot. It was a reminder that early adolescents need to know the risks of their medications and why nurses check things that seem insignificant.

My next clinical is tomorrow. Hopefully I can remember all the assessment techniques for pediatrics and focus on other important things. Like playing Candyland with a patient.

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2 Comments (+add yours?)

  1. Angela
    Jul 14, 2013 @ 22:11:10

    If you ever have difficulty placing an IV on a child, perhaps consider working with Certified Child Life Specialist. We are clinical professionals who specialize is just that! Plus, we are specially trained to demystify the medical environment through play therapy and health education with children of all ages. You can always check out my blog or the National Child Life Council for more information : ]) Most people have no clue our professions exists and are are helping children (and parents of young infants) overcome their medically related fears, especially fears surrounding needles.

    Reply

    • TallRayofSunshine
      Jul 15, 2013 @ 10:41:30

      The hospital where I did my clinicals has a specific team of people dedicated to pediatric blood draws and IV placement. The CLS’s at my hospital are definitely utilized across all units and are part of the integrated care for patients and their families. In this adolescent patient’s case, the IV team offering a numbing cold spray before placement was all that was needed to relieve anxiety. I have enjoyed being introduced to your profession and even suggested a friend of mine look into that career. Best of luck to you!

      Reply

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