141

27 Peripheral Intravenous Line Placement

28 Management of Extravasation Injuries

29 Umbilical Artery Catheterization

30 Umbilical Vein Catheterization

31 Peripheral Arterial Cannulation

32 Central Venous Catheterization

33 Extracorporeal Membrane Oxygenation Cannulation and Decannulation

34 Management of Vascular Spasm and Thrombosis

V Vascular Access

142

Mariam M. Said

Khodayar Rais-Bahrami

Peripheral Intravenous

Line Placement

27

Percutaneous Method

A. Indications

1. Administration of IV medications, fluids, or parenteral

nutrition when utilization of the gastrointestinal tract is

not possible

B. Equipment

Since the late 1960s, the variety of equipment available for

peripheral vascular access has grown from metallic needles

of limited size range and stiff polyethylene tubes, to an array

of plastic cannulas, single- and multilumen catheters of different sizes and materials, and totally implantable devices

(ports). The safest and more effective vascular access is

obtained by carefully matching the neonate’s size, therapeutic needs, and the duration of required treatment with

the most appropriate device and technique. Placement of

peripheral IV lines is described in this chapter. Placement

of central venous lines (excluding ports, which are not used

routinely in neonates) is described in Chapter 32.

Sterile (Fig. 27.1)

1. Povidone–iodine swabs or 70% alcohol swabs (or other

antiseptic; see Chapter 5)

2. Appropriate needle (minimum 24 gauge for blood

transfusion)

a. 21- to 24-gauge IV catheter (preferably shielded)

3. Connection for cannula (i.e., T connector)

4. 2- × 2-inch gauze squares

5. Isotonic saline in 3-mL syringe

6. Heparinized flush solution (heparin 0.5 to 1 U/mL normal saline) for heparin lock

Nonsterile

1. Tourniquet

2. Procedure light

3. Materials for restraint (see Chapter 4)

4. Transilluminator (optional, see Chapter 13)

5. Warm compress to warm limb if necessary (heel warmer)

6. Appropriate-sized arm board

7. Cotton balls

8. Scissors

9. Roll of 0.5- to 1-inch porous adhesive tape, transparent

tape, or semipermeable transparent dressings (1–5)

a. If using tape, use the minimum amount necessary

on fragile premature skin, and consider using a pectin barrier (DuoDERM, ConvaTec/Bristol-Myers

Squibb, Princeton, New Jersey; HolliHesive,

Hollister, Libertyville, Illinois).

b. Transparent tape or dressing will facilitate observation of IV site (Tegaderm, 3M Health Care, St. Paul,

Minnesota).

c. Precut self-adhesive taping devices are available

from Veni-Gard Jr. (ConMed IV Site Care Products,

Utica, New York).

10. Pacifier, if appropriate. Sucking releases endorphins,

which decrease pain. Consider tightly swaddling the

baby, leaving the limb needed for IV placement

exposed. Swaddling is also a comfort measure (see

Chapter 4). In additional, oral sucrose is frequently

used as a nonpharmacological intervention for procedural pain relief in neonates (6). Some critically ill

infants, such as those with persistent pulmonary hypertension, may require pain medication, sedation, and/or

paralysis prior to any invasive procedure, including IV

line placement.

C. Precautions

1. Avoid areas adjacent to superficial skin loss or infection.

2. Avoid vessels across joints, because immobilization is

more difficult.