3. Take care to differentiate veins from arteries.

a. Palpate for arterial pulsation.

b. Note effect of vessel occlusion.

(1) Limb vessel: Arteries collapse, veins fill

(2) Scalp vessel: Arteries fill from below, veins fill

from above

c. Note color of blood obtained (arterial blood is bright

red; venous blood is darker).

d. Look for blanching of skin over vessel when fluid is

infused (arterial spasm).

Chapter 27 ■ Peripheral Intravenous Line Placement 143

4. If limb requires warming prior to procedure, use a heel

warmer (Warm Gel, Prism Technologies, San

Antonio, Texas). “Homemade” compresses such as a

diaper soaked in hot water can cause severe thermal

injury.

5. Cut scalp hair using small scissors to allow for stabilization of the IV (do not shave the area) (see Chapter 5).

6. Apply tourniquet correctly (see Fig. 14.3).

a. Minimize time applied.

b. Avoid use in areas with compromised circulation.

c. Avoid use for scalp vessels.

7. When using scalp veins, avoid sites outside the hairline.

8. Be alert for signs of phlebitis or infiltration.

a. Inspect site hourly.

b. Discontinue IV immediately at any sign of local

inflammation or cannula malfunction.

c. Long plastic catheters are not recommended for

use in neonates because their relative rigidity

increases the risk of damage to the vascular endothelium, thus increasing the possibility of venous

thrombosis (7).

9. Arrange tape dressing at IV site to allow adequate

inspection or use transparent sterile dressing over site of

skin entry (8).

 Leibovici (9) was unable to show a positive effect of

a daily change of the dressing, as compared with a

change every 72 hours, on the incidence of infusion

phlebitis. Maki and Ringer (3) recommended not

removing the transparent dressing until the catheter/

needle is removed.

10. Consider using protective skin preparation in small premature infants to prevent skin trauma upon removal of

tape or dressing. No Sting Barrier Film (3M Health

Care, St. Paul, Minnesota) is a non–alcohol-containing

product that is available commercially; however, it, as

well as other commercially available skin protectants,

has not been tested on neonates.

a. Forms a tough, protective coating that bonds to

skin

b. Does not require removal when changing dressing

11. The use of tincture of benzoin and other products to

increase the adherence of tape should be limited, especially on the premature infant. These products create a

tighter bond between the tape and the epidermis than

the bond between the epidermis and the underlying

dermis. This then causes stripping of the epidermis

when the tape is removed. Using a protective skin preparation (e.g., No Sting Barrier Film) prior to the application of these products may decrease damage to the

skin when tape is removed (10).

12. Write date, time, and needle/cannula size on piece of

tape secured to site.

13. Loop IV tubing and tape onto extremity to take tension

off the IV device.

14. Limit to two to three placement attempts per person.

Monitor carefully for clinical decompensation, particularly in the very premature infant and in infants with

cardiac or respiratory compromise.

D. Technique

Prepare as for minor procedure (see Chapter 5). Ensure

that neutral thermal environment is maintained. It is often

necessary to transfer small infants to a radiant warmer for

peripheral IV placement to avoid cold stress. If the infant

has received a recent enteral feeding, consider delaying

the procedure until before the next feeding or placing a

naso- or orogastric tube to empty the stomach to prevent

aspiration.

1. Use transillumination to visualize vessel if needed (see

Chapter 13). Other modalities such as ultrasonography

(11,12) or bedside near-infrared light devices (13) may

also be used for vein identification.

2. Select vessel for cannulation. It is recommended to

begin with more distal sites and progress proximally if

needed. The following is the suggested order of preference (see Fig. 14.1):

a. Back of hand—dorsal venous plexus

b. Foot—dorsal venous plexus

c. Ankle—small saphenous, great saphenous veins

d. Forearm—median antebrachial, accessory cephalic

veins

e. Antecubital fossa—basilic or cubital veins

f. Scalp veins—supratrochlear, superficial temporal,

posterior auricular

3. Cut hair with small scissors close to scalp if using scalp

vessels.

4. Warm limb with heel warmer for approximately 5 minutes, if necessary.

Fig. 27.1. Sterile equipment necessary for peripheral IV line

placement.