IVs and You: Don’t get STUCK not knowing the lowdown

| December 6, 2017
Rams Head

Are you one of those people who hates going to the dentist because of the sound of the drill? Can’t tolerate that “hospital smell”…? Do you rip the paper examination gown every time you try to put it on (backwards)?

Well, I’m sort of with you. As odd as it sounds, I’m more than a bit terrible when it comes to facing needles on my own. When I worked in the Emergency Department at a large, urban children’s hospital one of my faculty colleagues would have to chaperone me to get my flu shot because I would almost PASS OUT. Absurd. Without blinking an eye, I’ve done a large number of medical procedures throughout my career that can resolutely be placed in the “gross” category and yet I need a chaperone to get my own small injection. In fact, when I had my 2 kids and an IV was required you would have thought that the highly technical microvascular surgical team was necessary, since I acted like this simple procedure was more complex than cutting edge robotics.

So, facing this head on, today we dissect that squirrelly anxiety producing procedure commonly known as the IV line.

The abbreviation IV stands for intravenous (25 cent word), with intra meaning “in” and venous representing “vein.” The IV equipment itself consists of 2 parts: the needle and the catheter. The catheter is a flexible, plastic straw that fits like a sheath around the needle, and is the only thing that stays in the body after the placement is complete. Once a tourniquet is applied and a suitable vein is located, the needle penetrates the skin and when it accesses the vein a confirmatory flash of blood is seen in the clear plastic hub at the top. The needle is then withdrawn while the catheter is advanced further into the vein until ultimately the needle is removed completely, leaving just the catheter in the vein. It is then either capped off or attached to tubing that can contain medicine and/or fluids in the line. The catheter is secured to the outside of the skin with a clear dressing and/or medical tape without obscuring it completely so the site can be regularly examined.

Sounds simple enough, right? All you tough grown up folks reading this are thinking “THIS IS NO BIG DEAL.”

Ok, imagine doing this procedure on a tiny premature infant. Or a squirming, howling toddler. Or a child with chronic illness who has had so many IVs that her veins are scarred down and difficult to access.  A bit of a game changer from the typical adult garden hose veins.

There’s no real magic in successful IVs, just practice and experience.  Well, and maybe a bit of voodoo, like always tearing off the right amount of tape BEFORE you even start. Some people repeatedly tap the skin after the tourniquet is applied to encourage the vein to “stand out,” and others use fancy equipment to identify the right location. Once the IV is in and secured, it really shouldn’t hurt. Sometimes people will describe being able to feel the cool temperature of fluids going in through the catheter but if there is pain at the IV site, then it should be assessed right away to make sure it is still patent and freely flowing.

Whatever the ritual, it’s always acceptable to ask WHY you or your child is getting this IV. Sometimes an IV will be placed at the same time a blood sample is drawn “just in case” IV medicines or fluids might be needed; and if blood is being drawn anyway, it saves another needle stick if the sample can be obtained at the same time as the IV insertion. Other times there may be a concern about a potential deterioration in a patient’s condition, so being ready to escalate intervention is simply being cautious and prepared. You should have a general understanding of why the IV is being established. Most of the time an IV is placed when medicines or fluids need to be delivered to the body quickly since IV formulations don’t need to be digested and absorbed in the gastrointestinal system.

Common reasons for getting an IV…

Dehydration: Whenever there’s a marked or prolonged decrease in liquid intake by mouth, and an increase in liquid output from vomiting, diarrhea or urination whether by a stomach flu, diabetes, or other cause, sometimes giving IV fluids rapidly and bypassing a sick gastrointestinal system restores hydration and electrolyte balance quickly and effectively. (That being said, for mild dehydration from something like a simple stomach flu we know that it’s best to give liquids in small amounts very frequently BY MOUTH.)

Medicine delivery: Some medicines need to get to the intended target quickly and for that reason they need to be given right into the vein. IV medicines are also used after a patient has tried a course of oral medicines without improvement.

There are, of course, a few tricks of the trade that might be helpful for you to know

  1. The IV should be placed in the location where it is most likely to be successful. Especially for younger children, it’s no fun for anyone to be involved in multiple needle sticks- as the recipient or the operator, so optimizing the chances for just one stick is key.
  2. If there are multiple potential good sites for placement, then putting the IV in the non-dominant upper extremity (the one NOT used for writing) is best because it allows for continuing usual activities easier.
  3. Don’t forget that there are veins everywhere. Sometimes the best vein for an IV in a baby who isn’t yet walking is the foot or right by the ankle. It’s not cruel or unusual; it’s simply about finding the best vein. Obviously the foot isn’t ideal for anyone who is walking.
  4. If you know that an IV is in your or your child’s future, being as well hydrated as possible increases the chances of IV success.  IVs are always more difficult to obtain and maintain in a dehydrated person.
  5. Speak up! If you know that you have a gigantic vein in the side of your wrist, or if your child has a stovepipe in the bend of her left arm, let your healthcare team know! And if you are uncomfortable with how the procedure is going, say so. Sometimes pausing a moment to regroup can improve a situation where everyone is tense.

Have YOU had an IV? Or your child? What was your experience like? Here at PM Pediatrics in Annapolis, I’m secretly looking for a few of you to be as much of a weenie as I am about this and come clean about it, but in the spirit of sharing all the knowledge, I welcome any and all stories, comments, and anecdotes.

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About the Author - Dr. Christina Johns, MD, MEd

Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from our highly skilled staff, with patients and families everywhere.

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