When I did my thousand hours in the hospital as a paramedic student, these tenured nurses in the ICU, emergency critical care, and anything pediatric emergency are such skilled personnel. My medic teacher always said paramedics were the most skilled IV practitioners, and while we may be good with no extra hands in the back of a bouncing ambulance, when I saw a nurse put a 20g into the back of a severely hypothermic, critical infants head in about 30 seconds I was in awe. The most unassuming, nice woman, just like the one in the video, and she did it like it was just another Tuesday. These people are incredible!
I am on the IV team at our hospital but its 99% adults. This video was super helpful and she is very knowledgeable nurse in the pediatric IV world. Very inspiring.
The most challenging part of IV insertion or any blood works for pediatrics is the mother or father hovering on you plus a baby doing a gymnastics and testing their lung capacities by crying out loud. if you’re a new nurse you’ll panic but as time goes you’ll get use to it.
Easiest thing to do is acknowledge that their lungs are working good and empathize with the parents. Then tell the parents that we need an IV but right now we are just going to look and see what we can find. This gives you time to explain what will happen and interact with the child and parents. They can quiz you and you can educate them about pediatric IVs. They will get more comfortable with you and you will realize that you know more than you think. :) Then, make sure you have a really good holder for the baby and put the parents to work if they can handle it. They (usually) want to be involved and will appreciate the fact that they contributed to the care for their child.
Great tips!! Retired Paramedic here....I always had success using a BP cuff. Apply BP cuff, identify the distal pulse, inflate just until you lose the pulse, then slowly deflate just until you feel the pulse. The idea is to stop the flow in the vein, while allowing the pulse pressure to build up, distending the vein. I been able to get a couple of choices on patients that others couldn't find anything.
Paramedic in Detroit, I can definitely use this to better my patient care. Thank you both and to everyone who has helped make this video. I find your videos to be very insightful and pertinent in bettering patient-care.
Incredibly helpful! As a midwife trying to cannulate some of the sickest HG moms this is incredibly helpful thank you. It makes so much sense I just never would’ve thought of these
Oh my, she just shoved it in. That's some experience. In my department the doctors do the IVs for all children under 2 years and even after 7 years of experience, I always feel a bit nervous when there's one that needs to be done. Some children just have too much adipose tissue and no visible veins. Thanks for the tip with 2 tourniquets. Great channel doctor Mellick, I wish I could be part of your team!
I worked as a pediatric IV nurse and highly recommend a Wee Sight, they are fairly cheap and can work wonders! Other transiluminators are also available with both red and white lights, depending on user preference. Thanks for the video!
Great video. I have been waiting for a good video on this topic for years. I learned a lot from watching the cannulation carefully as well as the tips. Could you post a video of some more cannulations? Perhaps with variations such as different sites, dehydrated kids? Thanks for all the hard work!
@@lmellick you got it! It's hard to come by real life educational medical videos -- that don't involve always involve popping cysts or shaving warts off toes! 🙂
Great video. Especially the idea how to get scalp vein bigger!! In our department of anesthesiology, We sometimes use nitroglicerin on the skin to make the veins bigger. Doing the iv after induction with Sevoflurane is our standard procedure. Or if you have time: EMLA(topical Lidocain+Prilocain)2 h before on, 1h before off, 1/2h before Midazolam juice (0,5 mg/kg). Our pediatricians sometimes use Livopan 50%/50% (O2:Nitrous oxid). When ever it is difficult get the Accuvein or an ultrasound machine especially in choppy kids. Love from Germany
Can also put the tape on the rubber band near where you will insert. That way you can lift the tourniquet over your IV. The other thing is to let the baby's head hang slightly over the edge of the bed - use gravity to engorge the veins. The other trick is to look behind the ears and follow up to the crown of the head - as you go - you are only 2 or 3 bifurcations from the external jugular.
Apply 2h before start of operation. Take off 1/2 h before start of operation and have the premedication given. This is important to reduce the vasoconstrictive properties of EMLA.
Any chance you and that nurse could do a video on infant/peds urinary strait cath tips/tricks? Seems to be an area that a lot of us non-pediatric ER nurses struggle with. I'd love to hear her advice.
Here is an unlisted video. I received complaints when I posted it to the public. That was understandable. However, it should be helpful. Please feel free to use it as needed. czcams.com/video/6SrP9VHd1BQ/video.html
Use lubricant and a 5fr feeding tube. If it's a clean catch, use a cold wet wash cloth on the groin and catch into a plastic bag or cotton balls. Take a 10cc and pull out the plunger. Place the urine soaked cotton balls in the syringe and replace the plunger. Now squeeze the urine out of the cotton balls and into the specimen cup. (26 years of Pedi/Neo ICU/Transport/ECMO.)
One of the toughest skills as a paramedic, because toddlers/babies are such a small segment of the patient population. I have IO'd more kids under the age of 5 than started IVs.
How would you stick a long term IV drug user that has wrecked all the obvious places. PIC under the arm? Or is there other options.? IV for pre-op surgery. I've always wondered about that. I was watching the baby,and was in awe that that huge needle went in the babies hand. I have narrowing of the arteries and I'm not an easy stick either. Woke up in an ICU unit double pneumonia. I was sure glad I didn't have to be awake for all that.
For peds and neos, always tape the arm to the armboard first. Put a plastic barrier under the hand. Then the wrist is in the correct position for the provider.
Often when cannulating a vein and you hit a valve you can attach your extension set and saline flush and gently push a little saline to open the valve and thread the cannula through.
@@andrewb.2014 some nurses and HCP can feel the valves when palpating the skin looking for veins. I havent been able to accomplish that yet. Is there a trick to accomplishing that?
All ok answers. but the best way is to occlude the vein distally and strip the vein towards the heart. You have now pushed all of the blood out of the vein back into the heart. Now look at the vein. The first spots that pop up afterwards are the valves in the vein due to the cartilage.
Pedi IV are usually a team effort. Get a team that supports your growth. Also, never tell the parents you are going to start an IV. Tell them you are going to look. That way they can relax and quiz you while you show that you know what you are doing and are gentle and caring with their child. Explain to them all of the reasons why pediatric IV are difficult and why you are carefully looking. Then, if you see something, go for it. That way you have already prepared the parents for a miss and your team has helped you practice your skills.
Rubbing the skin for warmth, tapping to raise veins, palpable the skin to see if veins you see as your choice pops back up. Insert at a slant into the skin in the vein...I use the butterfly on infants in most circumstances.
The person holding is more crucial than the person sticking. I wish we still had the 26g Insight angiocaths. A butterfly can get into veins that an angiocath cannot.
This is really true, I work with animals and the holder really makes a difference. Try placing a catheter in a small “stubby” let puppy screaming and struggling the whole time, you want a holder that knows what they are doing
@@benjaminshiffman8734 I'm four months into being a phlebotomist and during my training, I seemed to be the go to for holding a kids arm 🙄😂 My sop was to get a good hold, anchor the joint, have the parent hold them closely with their arm over the kids shoulder and chest, and the other around their middle and then try to get out of the sticking persons way. Lol
@@liseyzelle8073 You go in normally with the bevel up, once you get flash you flip the catheter so it is now bevel down, advance as you normally would, and then advance the catheter. If you are really talented you can actually go in bevel down right from the start, but I don't because we use the push button catheters and it would be too easy to hit the button prematurely! The point of the bevel down trick is to try and avoid going through the other side of the vein when you are placing an IV in a tiny vein.
When I did my thousand hours in the hospital as a paramedic student, these tenured nurses in the ICU, emergency critical care, and anything pediatric emergency are such skilled personnel. My medic teacher always said paramedics were the most skilled IV practitioners, and while we may be good with no extra hands in the back of a bouncing ambulance, when I saw a nurse put a 20g into the back of a severely hypothermic, critical infants head in about 30 seconds I was in awe. The most unassuming, nice woman, just like the one in the video, and she did it like it was just another Tuesday. These people are incredible!
I am on the IV team at our hospital but its 99% adults. This video was super helpful and she is very knowledgeable nurse in the pediatric IV world. Very inspiring.
Wee lights are good tools. We used to carry $5 red LED keychain lights on pedi transport. Did the same thing for $295 less.
The most challenging part of IV insertion or any blood works for pediatrics is the mother or father hovering on you plus a baby doing a gymnastics and testing their lung capacities by crying out loud. if you’re a new nurse you’ll panic but as time goes you’ll get use to it.
😂 😂 😂 😂 Gymnastics.. Facts with some humor. Best wishes
Hahaha exactly
Yes very much so I be ready to hand them the catheter like u got this or no they hover so bad.
Some parents are real bad
Easiest thing to do is acknowledge that their lungs are working good and empathize with the parents. Then tell the parents that we need an IV but right now we are just going to look and see what we can find. This gives you time to explain what will happen and interact with the child and parents. They can quiz you and you can educate them about pediatric IVs. They will get more comfortable with you and you will realize that you know more than you think. :) Then, make sure you have a really good holder for the baby and put the parents to work if they can handle it. They (usually) want to be involved and will appreciate the fact that they contributed to the care for their child.
Great tips!!
Retired Paramedic here....I always had success using a BP cuff. Apply BP cuff, identify the distal pulse, inflate just until you lose the pulse, then slowly deflate just until you feel the pulse. The idea is to stop the flow in the vein, while allowing the pulse pressure to build up, distending the vein. I been able to get a couple of choices on patients that others couldn't find anything.
Nice!
Awesome
2 BP cuffs, proximal and then apply distal - milk the blood down the extremity.
I have huge respect for people who can cannulate children.
In Finland, kids spit and bite. In France, they don't. I have decades' experience from both countries.
@@MarttiSuomivuori Thankfully, the kids here don't spit or bite.
Paramedic in Detroit, I can definitely use this to better my patient care. Thank you both and to everyone who has helped make this video. I find your videos to be very insightful and pertinent in bettering patient-care.
She’s awesome. Thanks for sharing
If my child was ill I would feel very relieved to have a nurse like her by my side.
Absolutely!!
Just graduated nursing school, start as a pediatric nurse Tuesday, totally appreciate the tips!
I love nurses like this. They're just invaluable sources of experience and knowledge.
Incredibly helpful! As a midwife trying to cannulate some of the sickest HG moms this is incredibly helpful thank you. It makes so much sense I just never would’ve thought of these
Glad it was helpful!
These are great! Huge respect to the presenter, 26years!
28 years here! You rock!
Oh my, she just shoved it in. That's some experience. In my department the doctors do the IVs for all children under 2 years and even after 7 years of experience, I always feel a bit nervous when there's one that needs to be done. Some children just have too much adipose tissue and no visible veins. Thanks for the tip with 2 tourniquets.
Great channel doctor Mellick, I wish I could be part of your team!
On chunky babies, they usually have small veins in the inner wrist.
These are all great tips that we learned in school!
I am an anesthesiologist here in Brazil and I learned a lot from this video. Great professional. thanks
Cool! I shared your comments with the nurse who helped make the video. She will be honored.
I love this channel. Amazing material that’s useful and very informative. ☺️❤️
I worked as a pediatric IV nurse and highly recommend a Wee Sight, they are fairly cheap and can work wonders! Other transiluminators are also available with both red and white lights, depending on user preference. Thanks for the video!
Thanks for the tip!
We used $5 red LED keychains on pedi transport.
Great video. I have been waiting for a good video on this topic for years. I learned a lot from watching the cannulation carefully as well as the tips. Could you post a video of some more cannulations? Perhaps with variations such as different sites, dehydrated kids? Thanks for all the hard work!
Glad it was helpful! We will consider that request. Thanks for the suggestion.
Amazing! Thank you! Did you perhaps make a video about IV help guide for geriatric patients?
Great tips! I love this channel. I learn so much from it.
Awesome! Thank you!
Thank you a lot! I am pediatrician and i appreciate what you do! Very helpful information!
Glad it was helpful!
Doc can see you at a million subscribers by end of year if you keep up with the videos like this 🙂
Thank you for the huge vote of confidence.
@@lmellick you got it! It's hard to come by real life educational medical videos -- that don't involve always involve popping cysts or shaving warts off toes! 🙂
Thank you so much
So many good tips
Really helpful
Good Job, thanks to big information for all nurse
I pray for you all..for healthy and good life... Because you all made this video...
GREAT VIDEO!!!! - Need to give specific credit to the nurse!
This is great. Thanks
Can you please show more pediatrics cases as in a PBL scenario
Thank you for the informative video just went from a hospital to a pediatric office as a phlebotomist this has been helpful
Great video. Especially the idea how to get scalp vein bigger!!
In our department of anesthesiology, We sometimes use nitroglicerin on the skin to make the veins bigger.
Doing the iv after induction with Sevoflurane is our standard procedure.
Or if you have time: EMLA(topical Lidocain+Prilocain)2 h before on, 1h before off, 1/2h before Midazolam juice (0,5 mg/kg).
Our pediatricians sometimes use Livopan 50%/50% (O2:Nitrous oxid).
When ever it is difficult get the Accuvein or an ultrasound machine especially in choppy kids.
Love from Germany
Can also put the tape on the rubber band near where you will insert. That way you can lift the tourniquet over your IV. The other thing is to let the baby's head hang slightly over the edge of the bed - use gravity to engorge the veins. The other trick is to look behind the ears and follow up to the crown of the head - as you go - you are only 2 or 3 bifurcations from the external jugular.
Could you please share details about emla application time,
Apply 2h before start of operation.
Take off 1/2 h before start of operation and have the premedication given.
This is important to reduce the vasoconstrictive properties of EMLA.
Cochrane reckons you don’t need to change cannula every 48-72 hours. Instead, only change if there’s signs of phlebitis
The only thing stopping nurses from doing our work esp with kids are 1. The problematic parents 2. The stupid policy
Some parents are so uncooperative 🤦
That suprises me. What do they do?
Exactly 💯
I'm so used to seeing butterfly needles for ivs and blood draws, so weird to see anything else
Keep going! Very useful stuff!
Thanks!!
I spent the whole night in my new Paeds rotation fixing line and 90% bailed on me.
Most hospitals have changed their policy and have removed the 4 day expiration of PIVs.
nice work thanks dr
In Canada they don’t change the iv after 72 hours anymore. They leave them if they are working and assess daily.
Makes sense!!
Marieke Dufresne they say preserving the veins is ideal and repoking people causes more damage and introduces more bugs.
Thankyou.. your videos are great.. love from Lebanon ❤
You're so welcome! Thank you for the kind words.
Wow great tips thanks
Any chance you and that nurse could do a video on infant/peds urinary strait cath tips/tricks? Seems to be an area that a lot of us non-pediatric ER nurses struggle with. I'd love to hear her advice.
Here is an unlisted video. I received complaints when I posted it to the public. That was understandable. However, it should be helpful. Please feel free to use it as needed. czcams.com/video/6SrP9VHd1BQ/video.html
Use lubricant and a 5fr feeding tube. If it's a clean catch, use a cold wet wash cloth on the groin and catch into a plastic bag or cotton balls. Take a 10cc and pull out the plunger. Place the urine soaked cotton balls in the syringe and replace the plunger. Now squeeze the urine out of the cotton balls and into the specimen cup. (26 years of Pedi/Neo ICU/Transport/ECMO.)
Love this lady. Have her do a video with idu.
new grad 7 months in PEDs ED and i wanna be you so bad. i feel like i’m getting worse at my IVs
Thank you that's really helpful
Glad it helped
Thank you for such a helpful video
You are very welcome!
One of the toughest skills as a paramedic, because toddlers/babies are such a small segment of the patient population. I have IO'd more kids under the age of 5 than started IVs.
i like you guys for this
blood draw from Newborns is really very hard to do need long great experience
Thanks for sharing
very helpful
How would you stick a long term IV drug user that has wrecked all the obvious places. PIC under the arm? Or is there other options.? IV for pre-op surgery. I've always wondered about that. I was watching the baby,and was in awe that that huge needle went in the babies hand. I have narrowing of the arteries and I'm not an easy stick either. Woke up in an ICU unit double pneumonia. I was sure glad I didn't have to be awake for all that.
Stick the wrist, anterior shoulder, feet, EJ or get the ultrasound machine or call anesthesia or surgery.
Would you mind giving some tips for arterial cannulation in baby without ultrasound? Thank you so much!
Great suggestion!
For peds and neos, always tape the arm to the armboard first. Put a plastic barrier under the hand. Then the wrist is in the correct position for the provider.
CHILD LIFE IS ALWAYS A GOOD IDEA
Great 🥰👏
Use the non dominant hand if possible.
IV drug users should all watch this to lower the risk and prevent possible infections and other health concerns, great video thanks!
Awosome
God sent
My question is about valve's. How do you feel for the valves in the veins??
Good question. Other than resistance, I don't know. Let me ask the expert.
Often when cannulating a vein and you hit a valve you can attach your extension set and saline flush and gently push a little saline to open the valve and thread the cannula through.
@@andrewb.2014 some nurses and HCP can feel the valves when palpating the skin looking for veins. I havent been able to accomplish that yet. Is there a trick to accomplishing that?
@@sheliabl91 With older patients I can sometimes palpate valves, There is also a good youtube if you google "How to identify valves in veins"
All ok answers. but the best way is to occlude the vein distally and strip the vein towards the heart. You have now pushed all of the blood out of the vein back into the heart. Now look at the vein. The first spots that pop up afterwards are the valves in the vein due to the cartilage.
need skills, some luck, and some witchcraft. I'll sacrifice a goat if I have to get a hard stick.
So true😂😂😂
im taking the guess that im not first.
Any tips for a beginner? I've been training at home for a couple months
Nothing more than just be patient with yourself.
@@lmellick hahaha I see what you did there
@@pimpz7409 No, actually was not trying to be funny.
Do 20 cannulations 21 will be yours
Pedi IV are usually a team effort. Get a team that supports your growth. Also, never tell the parents you are going to start an IV. Tell them you are going to look. That way they can relax and quiz you while you show that you know what you are doing and are gentle and caring with their child. Explain to them all of the reasons why pediatric IV are difficult and why you are carefully looking. Then, if you see something, go for it. That way you have already prepared the parents for a miss and your team has helped you practice your skills.
Which vein did she say is always there
saphenous vein
Also for securing the site in super wild or spicy kids we would do the loop and then splint their wrist or elbow.
Best to tape above the site - double back completely on the tubing. Then place another piece of tape on top of that. Cover with Koban.
Is this Nurse Jackie?!
No, that's not her name.
Rubbing the skin for warmth, tapping to raise veins, palpable the skin to see if veins you see as your choice pops back up. Insert at a slant into the skin in the vein...I use the butterfly on infants in most circumstances.
The person holding is more crucial than the person sticking. I wish we still had the 26g Insight angiocaths. A butterfly can get into veins that an angiocath cannot.
This is really true, I work with animals and the holder really makes a difference. Try placing a catheter in a small “stubby” let puppy screaming and struggling the whole time, you want a holder that knows what they are doing
@@benjaminshiffman8734 I'm four months into being a phlebotomist and during my training, I seemed to be the go to for holding a kids arm 🙄😂
My sop was to get a good hold, anchor the joint, have the parent hold them closely with their arm over the kids shoulder and chest, and the other around their middle and then try to get out of the sticking persons way. Lol
slapping the veins make them more easier to burst, it s not good idea.
Ommmm
Talk easy i.v. difficult.
Excey
What’s DK?
DKA. Diabetic ketoacidosis
Dka =diabetic ketoacidosis IV for fluids electrolytes
Geeez no topical anesthetic ????
their babies, they get over it
PEDS !!! ... :/ LOL
Don't forget the bevel down trick...
Please explain the bevel down trick
@@liseyzelle8073 You go in normally with the bevel up, once you get flash you flip the catheter so it is now bevel down, advance as you normally would, and then advance the catheter. If you are really talented you can actually go in bevel down right from the start, but I don't because we use the push button catheters and it would be too easy to hit the button prematurely! The point of the bevel down trick is to try and avoid going through the other side of the vein when you are placing an IV in a tiny vein.
@@bettysmith4527 k
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