An intravenous (IV) line delivers fluids, medications, and nutrients directly into the bloodstream. While commonly placed in hands, arms, or feet, infants often require alternative sites due to their small, delicate veins. In many cases, healthcare providers choose a scalp vein for IV access, especially when other peripheral veins are difficult to access.
Reasons for Scalp IV Placement
Scalp IV placement is often chosen due to anatomical advantages and clinical needs. Infants have smaller peripheral veins, which can be difficult to visualize and access, particularly if they have more subcutaneous fat or are prone to vasoconstriction. Scalp veins, conversely, tend to be more superficial with less overlying fat, making them more visible and easier to cannulate.
Another significant advantage of scalp veins is their relative stability. Unlike veins in the limbs, which are susceptible to movement and dislodgement, scalp veins are located in an area with minimal joint movement, which helps secure the catheter in place. This reduced mobility lowers the risk of accidental removal or infiltration, where fluids leak into surrounding tissues. Healthcare providers may also opt for a scalp IV when attempts to insert an IV in other peripheral sites, such as the hands or feet, have been unsuccessful. Utilizing scalp veins can also help preserve veins in the arms and legs for future, potentially longer-term, vascular access needs like peripherally inserted central catheters (PICCs).
The Scalp IV Insertion Process
Inserting a scalp IV involves careful steps to ensure the baby’s safety and comfort. Healthcare professionals begin by identifying a suitable vein, often in areas like the superficial temporal, frontal, or posterior auricular regions of the scalp. A small section of hair may be clipped or shaved to allow for clear visualization of the vein and proper adherence of the dressing, although hair removal is not always necessary. The site is then thoroughly cleaned with an antiseptic solution. To make the vein more prominent, a soft elastic band might be placed around the baby’s head as a temporary tourniquet, or gentle pressure may be applied.
The healthcare provider stabilizes the chosen vein and inserts a small, flexible catheter, typically a 24-gauge size, at a shallow angle into the vein. A “flashback” of blood in the catheter hub confirms successful entry into the vein, at which point the needle is withdrawn, leaving only the soft catheter in place. The catheter is then secured to the scalp with medical tape and a transparent dressing, sometimes with additional padding or a protective cup to prevent pressure points and dislodgement. Measures such as swaddling, non-nutritive sucking (e.g., a pacifier), or administering a sucrose solution can be used to help comfort the baby during the procedure.
Caring for a Scalp IV
Proper care of a scalp IV prevents complications and ensures continuous treatment. The IV site must be kept clean and dry at all times, with parents instructed not to remove the dressing or tape securing the catheter. Regular observation of the site helps detect early signs of potential issues. Parents should frequently check for redness, swelling, warmth, tenderness, or any fluid leakage around the insertion area.
Other signs that may indicate a problem include the IV tubing not dripping, the baby showing increased fussiness or pain when the IV is touched, or a fever. If any of these signs are observed, or if the IV appears to be dislodged, parents should immediately contact their healthcare provider. It is important to prevent the baby from touching or pulling at the IV line, and activities that could lead to dislodgement, such as rough play or getting the site wet, should be avoided.
A peripheral IV in an infant typically remains in place for 1 to 3 days before needing replacement, though this can vary. When removal is necessary, a healthcare professional will carefully detach the dressings and withdraw the catheter, applying pressure to the site until any bleeding stops.