Intravenous (IV) lines deliver fluids, medications, or nutrition directly into a person’s bloodstream. For infants, these lines are often necessary when they cannot take substances by mouth, require rapid delivery of treatments, or need continuous support for various health conditions.
Common IV Sites in Infants
Healthcare providers choose specific locations for IV insertion in infants due to their vein characteristics and the need for stability. The back of the hand (dorsum) is a common site because its veins are often visible and accessible. This location also allows for easy stabilization of the IV site.
The top of the foot (dorsum) is another frequently used area. This site is often selected because limiting a baby’s foot movement is simpler than restricting hand movement, which helps secure the line. Veins in the feet can be prominent and are suitable until a child begins standing or walking.
For very young infants, especially neonates, the scalp can be an effective site for IV placement. Scalp veins are often visible and lack valves, which can make catheter advancement easier. The scalp also offers a stable surface for securing the IV.
Factors Guiding Site Selection
Medical professionals consider several factors when placing an IV in an infant. The baby’s age and overall size play a role, as smaller infants have more delicate veins. The condition of the baby’s veins, including their visibility, palpability, and any prior attempts at IV placement, influences the choice. Applying warmth to the area can help distend the veins, making them easier to locate.
The specific type of fluid or medication to be administered is also taken into account. Some solutions are more irritating to veins and require placement in larger vessels or sites that can tolerate them better. The anticipated duration of the IV therapy guides site selection, with some locations more appropriate for short-term use versus prolonged treatment. Preserving veins for future access is also a consideration, often leading providers to start with the most distal sites.
The baby’s activity level and mobility also factor into the decision. A site that can be adequately immobilized to prevent dislodgment is preferred. The baby’s general medical condition and any existing diagnoses further inform the selection process.
Alternative IV Access Points
While common sites are preferred, alternative locations or methods for IV access may be necessary. The antecubital fossa, at the inner elbow, can be used, though it is less desirable for long-term IVs due to constant joint movement. Veins in the ankle, such as the saphenous vein, also offer viable access when other peripheral sites are not suitable.
In cases requiring longer-term intravenous support, such as for several weeks, peripherally inserted central catheters (PICC lines) are often considered. These thin, flexible tubes are inserted into a peripheral vein, typically in the arm or leg, and then carefully threaded into a larger vein closer to the heart. PICC lines provide stable access for medications and nutrition, and reduce the need for frequent needle sticks.
For newborns, especially those who are premature or critically ill, umbilical venous catheters (UVCs) offer immediate vascular access shortly after birth. These catheters are placed into the umbilical vein, which remains open for about a week after birth, allowing for the administration of fluids, medications, and nutrition. In instances where other options are not feasible for long-term needs, central venous lines may be placed in larger veins in the chest or groin.
Caring for a Baby’s IV
Careful monitoring of the IV site is important for the baby’s well-being. Healthcare staff typically perform hourly assessments to check for signs of potential issues. Parents can help by observing for swelling, redness, pain, coolness to the touch, or any wetness around the IV site, which can indicate a complication known as infiltration.
Protecting the IV site is a key aspect of care. The site is usually covered with a transparent dressing and secured with tape to prevent dislodgment. Specialized protective covers, such as domes, can provide an additional layer of protection against bumps. It is advised to keep the IV site dry, avoiding direct water exposure during baths.
Comforting a baby with an IV involves gentle handling and ensuring the tubing is not pulled or caught. Swaddling can help provide containment and comfort, while offering a pacifier or sucrose solution can soothe the baby during procedures. Parents should alert medical staff if the pump alarm sounds, if the baby pulls at the tubing, or if any changes are noticed at the IV site.