4 Top Tips to IV Insertion in Babies

Peripheral IV access can be really tough to secure in a baby. Inserting an IV catheter in chubby, sick, or small babies can be particularly challenging. Infants are wriggly, have small veins, and excess adipose tissue often obscures the veins and makes it even more difficult. These factors contribute to the challenges of placing an IV line in babies. During the induction of anesthesia, bradycardia, laryngospasm, etc may occur, making it imperative to quickly secure an IV except for the very short surgical procedures, which adds additional stress and pressure for everyone involved.

If this happens in the operating room, it can make for a terrible start to the day. In this video, we share 4 important tips that will substantially increase your success in securing an IV in a baby.

1. Select the optimal gauge catheter

The best IV catheter size for most babies is a short, 24-gauge catheter. Even if you have witnessed others trying large gauge, such as 22-gauge in little babies, they often fail. More importantly, a larger gauge IV is typically not needed. As an example, a 24-gauge IV has a free flow rate of 20 mL/min, which is the equivalent of two 18-gauge IVs running wide open in an adult.

2. Choose the best site for IV

While there are a few options for where to place a pediatric IV, these are the two best locations for most indications:

• Feet. Many infants have a long saphenous vein contributory or the saphenous vein itself running up the middle of their anterior foot. Moving the foot is easier limited and IV line secure compared to the more movable hand.
• Hands. Most infants have at least one vein running up the middle of their hand. You can use transillumination to identify the veins. In this video, we will feature IV placement in the hand.

Holding the child still is the most important part of starting a line in an infant. They are going to move and if they do, IV access is next to impossible.

Use the free hand to both pull the skin tight, immobilize the hand, and fix the vein. Importantly, tensing the skin to stabilize and fix the vein must be done skillfully so that the vein does not “roll” off the needle. Still, the stabilization of the vein should not impede its filling or decrease the diameter of its lumen.

Let’s see the video of how an expert inserts the IV line in an infant.