Catheter Selection

1. Butterfly. Only used for scalp veins, sometimes used for obtaining blood samples.
   NS-ANP /Dr. procedure only. Discouraged due to shorter dwell time.
2. Surflow: Radiopaque Teflon. (current catheter used in newborn services is the Terumo Surflow in sizes 24 gauge, and 22 gauge).

Vein Selection

• The first choice of sites is the periphery to maximize available vein sites. In neonates, the veins of the anterior aspect of the hands and feet are the most visible.
• Scalp IVs are to be avoided. If necessary, this is usually performed by an ANP or Registrar. Scalp IVs may be culturally inappropriate (in Maori and other cultures).
• Veins used for long line insertion are not to be cannulated. (Long saphenous and brachial veins – refer diagram)

Select a site in where

• the vein is relatively straight
• the area is not bruised
• there is a vein that has not been infiltrated previously.

If there is difficulty finding an appropriate site, notify the medical staff to assist.

Consider:

• the baby's size, age, and gestation
• the type and rate of infusion(s) and/ or medications infusing
• why the baby needs an IV.
  • Is this the baby's last dose of antibiotics?
  • Could they be given I.M. instead?
  • Is the baby almost on full feeds?

Differentiating between Veins and Arteries (refer to diagrams below)

1. When palpated, artery pulses (but not always)
2. Artery blanches when flushed
3. Artery has bright red blood
4. Avoid ventral (flexor) surface of forearm near the wrist if possible.
5. It is difficult to distinguish arteries and veins in an infant’s scalp

Complications of IV Cannulation

1. Local and systemic infections
2. Phlebitis
3. Thrombus
4. Air Embolism
5. Accidental insertion into an artery
6. Bleeding if disconnected
7. Extravasation

Recognition and Prevention of IV Infiltration Injuries

• An IV infiltration can be disastrous to a neonate's skin. Sloughing and tissue necrosis can occur, as well as full thickness skin and muscle necrosis is possible.
• Plastic surgery may be necessary in extreme cases.
• It is extremely important to observe IV sites closely, at least hourly, more often in cases of high infusion rates, caustic solutions, and small fragile veins.

Signs and symptoms of infiltration include:

• swelling
• pain
• coolness of skin
• leakage at site
• erythema
• blistering
• lack of blood return

Prevention Measures

• Avoid butterflies for infusion.
• Avoid areas difficult to immobilize.
• Avoid dorsum of foot in active babies, especially larger babies in cots. Always expose the IV
   site if the baby is in a cot
• Secure so site is clearly visible.
• Tape loosely enough to maintain circulation.
• Limit glucose concentrations to 12.5%. Amino acids > 25% require central line.
• Dilute medications per drug protocol.
• Assess catheter site and distal region hourly
• Stop infusion immediately if signs of infiltration are present.  Follow RBP guidelines for IV infiltration. Refer intravascular catheter guidelines

Taping Peripheral IV Cannulae

It is expected that:

• IVs are taped so the site directly over the tip of the cannula is visible for observing signs of infiltration.
• Tape is not to be placed over pre-existing tapes. If an IV require re-taping, existing tape must be removed first.
• Tape so that it will be easy to remove. Consider making tabs at the ends of each tape to help with easier removal. DO NOT use scissors to remove tapes.
• Nailbeds need to be visible for assessing peripheral circulation. Do not tape too tightly which could interfere with circulation of the extremity.
• Tape in a way that is developmentally appropriate for that baby. If the IV is in the hand, ensure fingers are flexed over armboard and thumb is free. Feet are to be taped in an anatomical position with toes visible. Minimize restrictive movement as much as possible. Make sure baby will be comfortable after taping.
• Tape in a way that is appropriate for that particular gestation. ELBW babies require Coban dressing (stretchy gauze) and minimal use of adhesive tape due to the fragility of their skin. Extra small armboards (handmade from gauze and cloth tape) are also useful.
• Tape according to the unit guidelines. Do not use an excessive amount of tape.

Diagrams of Vein and Artery Positions

Anatomy of veins over the hands and feet

Main Veins`of the Arm

Superficial veins of the legs

Main Arteries of the Arm

Popliteal Artery and its Main Branches

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