Pediatric emergency medicine trisk 4334 4334

Procedure
The infant younger than 1 year of age has several easily accessible scalp veins.
These include the frontal, supraorbital, posterior facial, superficial temporal, and
posterior auricular veins and their tributaries. Restrain the patient in a supine
position and have an assistant stabilize the infant’s head. After assessment for the
most accessible veins, shave an area large enough to expose not only the desired
veins, but also an area of surrounding scalp for adequate taping of the infusion
needle or catheter. In this area, select a vein with a straight segment that is as long
as the part of the needle or catheter that is to be inserted. Verify the chosen vessel
is a vein by palpating it to ensure it does not pulsate.
Place a rubber band around the infant’s head after attaching a small piece of
tape to the rubber band to make it easier to lift and cut the rubber band after
successful venipuncture.
Prepare the skin by cleansing with antiseptic solution and allowing it to dry.
Grasp a butterfly scalp vein needle by the plastic tabs or “wings” or the over-theneedle catheter at the base. Keep the needle and syringe unattached initially to
facilitate evaluation of free blood return. Insert the needle in the direction of
blood flow and pierce the skin approximately 0.5 cm proximal to the actual site
where entry into the vein is anticipated ( Fig. 130.7 ). While applying mild
traction on the skin of the scalp, slowly advance the needle through the skin
toward the vein. Blood will enter the clear plastic tubing of the butterfly or the
plastic tubing of the catheter with entry into the lumen of the vein. Carefully cut
the rubber band tourniquet, attach the syringe filled with saline flush solution, and
slowly inject 0.5 mL of flush. If the needle is satisfactorily inserted into the lumen
of the vein, the solution will flow easily. For catheterization, thread the catheter
over the needle further into the vein continuing to assess for flow. Appearance of
a skin wheal when flushing the catheter indicates that the vein has not been
satisfactorily cannulated, and another attempt must be made.
After successful catheterization, carefully tape the scalp vein needle or catheter
as shown in the diagram. To prevent accidental removal or infiltration of the vein,
look for ways to position the infant safely.

UMBILICAL ARTERY CATHETERIZATION
Indications
Respiratory failure or cardiovascular collapse in the newborn infant for whom
percutaneous attempts for vascular access have failed. Used for resuscitation,