PEM Playbook – Pediatric IV Tips and Tricks

Originally published at Pediatric Emergency Playbook on February 1, 2021 – Visit to listen to accompanying podcast. Reposted with permission.

Follow Dr. Tim Horeczko on twitter @EMTogether


Top 10

[details in audio]

  1. Set the stage – exude confidence and be prepared

  2. Choose the right cannula size – a smaller working IV is infinitely better than none

  3. Feeling is better than looking – trust yourself

  4. Mark the site – things get wonky when you take your hands off to disinfect

  5. Tourniquets can mess you up – try to use a holder’s hand to occlude the vein

  6. The holder rules – get as many hands on deck as you need.

  7. Tension is good –  a little counter traction on the skin with your non-dominant hand helps to decrease the friction as the needle goes through the fascial layers.

  8. Stay in line – your needle is an extension of your arm

  9. Gravity is your friend – the kinder, gentler tourniquet

  10. The 3 Fs – flash, flatten, and forward. Get the flash at a 30 degree angle, flatten that angle, (advance another 1mm), and advance the plastic catheter over the needle into success

Fantastic tutorial by Brienne Leary, Medical-Surgical ICU nurse from Boston Children’s Hospital
Excellent start-to-finish demonstration and example by Dr Aman Kalra, Pediatric Anesthesiologist at Tufts Medical Center
The one-and-only Dr Larry Mellick interviews seasoned pediatric emergency RN

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