Tips & Advice for Newborns (Neonatal IV Insertion)

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Miriam Wahrman
MSN/Ed,RNC-MNN
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Outline

Nursing Points

General

  1. Supplies
    1. Gather all the supplies and have them ready
      1. Friend- it helps to have extra hands
      2. 24G IV catheter
      3. Pigtail/extension set
      4. Armboard
      5. Heal warmer
      6. Alcohol/betadine
      7. Clear tape
      8. Tourniquet/rubber band
      9. Tegaderm
      10. Cotton balls
      11. Transducer
      12. IV flush (3ml-too much pressure from a 10ml can blow the vein)
  2. Positioning
    1. On a warmer – need to provide warmth
    2. Cover eyes with their hat-block the light out for more comfort
  3. Tips & Tricks
    1. Put a cut (clean with alcohol) rubber band on the upper arm and see what you can see
      1. DO NOT leave the tourniquet on for too long, occasionally remove and let blood flow enter the extremity
    2. Rub hard with alcohol to try and get veins to “pop”
    3. You can also use heat from the heal warmer on the location you are assessing
    4. A transducer can help show where the veins run if you can not see one
  4. Insertion
    1. Alcohol or betadine the location
    2. Insert at a 10-degree angle
    3. See the flash? gently push the catheter all the way in and remove the needle
    4. Attach a FLUSHED extension set and flush the IV (This is where the extra hands help)
      1. Flushes smoothly? Great
      2. Has IV blown? Remove and attempt a different location
    5. Secure the line
      1. Apply the Tegaderm and tape to secure
      2. Apply arm board to keep arm straight and tape
      3. If IV is in the hand
        1. Cotton ball under the IV if it sticks out past the hand to secure it from being bumped and pulled

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Transcript

Hey guys, today I’m going to go through setting up a newborn IV and inserting it. Unfortunately, we don’t have a baby here for me to actually insert one on, but I’m going to walk you through all the steps to hopefully make it easier for you whenever you have to do this. So the one important thing with newborns is that you obviously want to make sure your hands are clean as with any patient, but on a newborn you want to be bare from the elbows down. So no rings, watches or anything that could carry germs to this newborn. So I have done that and now I’m just going to put my gloves on so we are ready. So one of the things, usually you’ll have a baby on a radiant warmer, to have the extra bright light on them so you can visualize the veins and what you’re doing. 

So you want to just take their hat and we pull it over their eyes just to help block out that light cause it’s so much stimulation. They’re used to a really dark environment and now they’re out in all these bright lights around. So use that to cover just over their eyes. So that we block some of the light out. The next thing is you want to make sure you have all your supplies set up and get your tape ready. So these little babies get a little bit combative and it can be hard to juggle all the things. So you want to have everything set up. So you want to have a few of the large pieces of tape and you can just hang them on the sides of your warm or table or wherever you’re inserting the IV. And then you want to have some, thinner pieces you can tear to do your chevrons. Okay? The next thing you want to make sure everything is prepped. So, you are going to saline, flush your pigtail. 

Okay. After you guys have flushed your extension set and that is ready, you will move on to placing the IV. So you’re going to put your tourniquet on. So we use rubber bands at our facility and anywhere I’ve seen, if you do this, you just want to wipe them down really well with alcohol. You will tie it around the baby’s arm and do your release quick release, not so you can quickly release that tourniquet. We don’t want to leave the tourniquets on more than like a minute or so because we don’t want to cut off blood supply to long to that extremity. So you are going to do that and you’re going to rub kind of aggressively with the alcohol wipes so that you can cleanse the skin but also try to get those IVs to pop. Unfortunately, newborns are hard to place an IV on because they’re a little bit dehydrated. Sometimes those veins, they’re very fragile and then they’re flat cause they already hydrated. All right. When you find that vein, you are going to place your IV. 

So you have your IV, this is the type that, we have here, but you might have a different one in your facility. So you will get it into the vein. You only want to be at like a 10-degree angle, so not too high because we don’t want to go too deep. And keep it superficial. You will insert that IV and get it in. Hopefully see a flash of blood in there and then you know you are good. So once that end this will go to your sharps container. So you have your IV in place and then you are ready to quickly cause blood is coming out of this attach and you are going to flush with a 10 CC syringe. You want to be really careful not to push too hard cause you don’t want to blow that Bain. So you are going to just gently push through and flush it. Once that is good, you can hopefully have extra hands helping you here. Lock that. Now that you’ve gotten that in, we are going to Chevron and get this thing secured. We use a lot of tape. The next thing. Once that’s there you’ll get your arm board ready because you don’t want to have the IV in their AC. And then there’ll be bending their arm a lot of getting into fetal position. So this way the arm board will help keep that arm straight. So you’ll be getting that ready. You will Tegaderm and you just want to be careful not to cover too much of that lower part. 

So we have our Tegaderm in place and then even more tape on this arm board to secure the baby’s arm to it. So sometimes if you have the IV down here, it’s a small surface area space. So we need to make sure that if the baby is going to bump this, it’s not going to dislodge the IV. So sometimes we will tear a cotton ball and place a piece under and add even more tape around that to secure that these kids are covered in tape when we’re done. That’s putting an IV. The last thing you want to do is re-stick them. All right. So if you have this all set, you flushed the line and have it locked, you can disconnect and then you’re ready to give whatever medication you need to get. I hope this helps you guys, so you’ll be ready to start those newborn IVs and be successful. Now go out and be your best self and as always, happy nursing.

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Nursing Clinical 360

With the rapid expansion of the COVID-19 pandemic many schools, instructors and students are left wondering what just happened?Students can’t access the tools and onsite clinical help they desperately need and instructors are trying to piece together online learning that prepares their students for success.It is because of this uncertainty and abrupt change that we have developed the Nursing Clinical 360 Course.Featuring:38 Highly Detailed Nursing Skills Video Lessons18 Health Assessment Lessons26 IV Skills Videos42 Case Studies30+ Care PlansWe want to give students the practical knowledge they need to feel confident going into a clinical or practical situation, as well as give instructors a concise library of online resources to handle the sudden demand for distance learning.

Course Lessons

1 - Head to Toe and Health Assessment
Intro to Health Assessment
Barriers to Health Assessment
The 5-Minute Assessment (Physical assessment)
Adult Vital Signs (VS)
Pediatric Vital Signs (VS)
General Assessment (Physical assessment)
Integumentary (Skin) Assessment
Neuro Assessment
Head/Neck Assessment
EENT Assessment
Heart (Cardiac) and Great Vessels Assessment
Thorax and Lungs Assessment
Abdomen (Abdominal) Assessment
Lymphatic Assessment
Peripheral Vascular Assessment
Musculoskeletal Assessment
Genitourinary (GU) Assessment
2 - IV Insertion
Supplies Needed
Using Aseptic Technique
Selecting THE vein
Tips & Tricks
IV Catheter Selection (gauge, color)
IV Insertion Angle
How to Secure an IV (chevron, transparent dressing)
Drawing Blood from the IV
Maintenance of the IV
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
Needle Safety
IV Drip Therapy – Medications Used for Drips
IV Drip Administration & Safety Checks
Understanding All The IV Set Ports
Giving Medication Through An IV Set Port
How to Remove (discontinue) an IV
IV Placement Start To Finish (How to Start an IV)
Bariatric: IV Insertion
Dark Skin: IV Insertion
Tattoos IV Insertion
Geriatric: IV Insertion
Combative: IV Insertion
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
3- Nursing Skills
Nursing Skills (Clinical) Safety Video
Bed Bath
Linen Change
PPE Donning & Doffing
Sterile Gloves
Mobility & Assistive Devices
Spinal Precautions & Log Rolling
Restraints
Starting an IV
Drawing Blood
Blood Cultures
Central Line Dressing Change
Inserting a Foley (Urinary Catheter) – Female
Inserting a Foley (Urinary Catheter) – Male
Trach Suctioning
Trach Care
Inserting an NG (Nasogastric) Tube
NG (Nasogastric)Tube Management
NG Tube Med Administration (Nasogastric)
Stoma Care (Colostomy bag)
Wound Care – Assessment
Wound Care – Selecting a Dressing
Wound Care – Dressing Change
Wound Care – Wound Drains
Pill Crushing & Cutting
EENT Medications
Topical Medications
Drawing Up Meds
Medications in Ampules
Insulin Mixing
SubQ Injections
IM Injections
IV Push Medications
Spiking & Priming IV Bags
Hanging an IV Piggyback
Chest Tube Management
Pressure Line Management
4- Nursing Care Plans
Purpose of Nursing Care Plans
How to Write a Nursing Care Plan
Using Nursing Care Plans in Clinicals
Nursing Care Plan (NCP) for Abdominal Pain
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Benign Prostatic Hyperplasia (BPH)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Cholecystitis
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Endocarditis
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Parkinson’s Disease
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Seizures
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Rheumatoid Arthritis (RA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Glomerulonephritis
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Renal Calculi
5- Nursing Concept Maps
Concept Map Course Introduction
Coronary Artery Disease Concept Map
COPD Concept Map
Asthma Concept Map
Pneumonia Concept Map
Bowel Obstruction Concept Map
Gastrointestinal (GI) Bleed Concept Map
Congestive Heart Failure Concept Map
Hypertension (HTN) Concept Map
Breast Cancer Concept Map
Amputation Concept Map
Sepsis Concept Map
Stroke Concept Map
Depression Concept Map