Intravenous (IV) therapy is the quickest and most effective way to administer medicine or fluids to an ill infant. Because of this reason, it is commonly used in pediatric therapy. Undeniably, IV insertion among infants and children is one of the most daunting tasks for nurses. For pediatric patients, we could say it is also one of the most traumatic experiences.


Although nurses want to make this experience as smooth and pain-free as possible, young patients stress out just the mere sight of IV needles and people wearing white uniforms. Plus a child’s limited understanding and development pose an extra challenge to the IV therapist or nurse. Fragile veins and edematous tissues further add challenge to pediatric IV insertion. Despite the difficulties, IV therapy is used because of the following reasons:

  1. Maintenance of fluid and electrolyte balance
  2. Produce therapeutic levels of the drugs in the body quickly
  3. Rehydration
  4. Nutritional support

Infusion of IV fluids can either be via a peripheral vein, a central venous access device or a peripherally inserted central venous catheter. To prevent fluid overload, a calculated rate and amount of IV fluids are prescribed to pediatric patients.

Tips for Pediatric IV Insertion

Most new nurses find pediatric IV insertion difficult. The key to mastery of this procedure is practice, practice and practice. Here are few tips for a successful IV insertion:

Provide distraction. When implemented in a creative manner, a child’s thoughts on ‘getting hurt’ are diverted to a positive experience. For preschool and school-age kids, letting them blow bubbles, sing their favorite song or perhaps asking them to count provide creative distractions. Nurses can also play the kid’s favorite cartoon TV show to divert their attention. If parents brought iPads with them, asking them to play a child-engaging video clip has been found very effective.

Use Less Invasive Restraining Technique. As mentioned, IV insertion is a daunting experience for the young ones. Restraining children during the procedure may add more psychological stress. Strict restraining procedures should NEVER be a nurse’s first course of action. In cases where restraining is necessary, less invasive restraining procedure can be employed such as asking the mother or father to hug the child during IV insertion. This controls body movements while shooting that vein and provides warmth and emotional support to the patient.

Choose IV Insertion Site Base On Age. Age-appropriate IV sites make insertion less difficult for both the nurse and the patient. For neonates, scalp veins are most appropriate and give easy access to IV insertion. This area is discouraged among the older infants though since they might displace the device inserted due to massive movements. Veins in hands and feet are perfect sites for all pediatric patients. However, the foot should be used only for infants who are not yet walking. Also as much as possible, do not insert on the hand the child uses for thumb sucking otherwise the device might be dislodge requiring re-insertion.

Ask The Parents to Stay Beside The Child. Reduction of anxiety for children equals the presence of their major support mechanism – the parents. Whilst older children stay calm despite their absence, 7 years old and younger usually needs the participation of parents in this stress-stimulating procedure. To get parents’ full participation, a nurse should explain the procedure and its purpose to them first.

Determine And Use The Appropriate Needle Size. 22- or 24- needles should be used for pediatric patients. The smallest gauge catheters have the shortest length that delivers fluids to the body. For neonates, a 24-gauge IV device is recommended while 24- or 22- gauge for older children.

Guard IV Site for Dislodgement. Curiosity and active movements are natural among young patients. During hospitalization, it is important to guard the IV site to be dislodged from the child’s curiosity to device inserted or movements. Hence, transparent devices or colorful stockinette bandages are used for these patients. If the insertion site is near the joint, it is advisable to use an arm board to prevent dislodgement. Just place adequate pads with the board to prevent skin integrity damage.

Is it possible to achieve venipuncture without pain? That would be almost impossible. However, it is possible for the nurse to turn this daunting experience worthwhile.


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