Tips & Advice for Newborns (Neonatal IV Insertion)

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Miriam Wahrman
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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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NP4 exam1

Concepts Covered:

  • Circulatory System
  • Urinary System
  • Noninfectious Respiratory Disorder
  • Respiratory System
  • Integumentary Disorders
  • Respiratory Disorders
  • Labor Complications
  • Disorders of Pancreas
  • Pregnancy Risks
  • Cardiac Disorders
  • Eating Disorders
  • Respiratory Emergencies
  • Infectious Respiratory Disorder
  • Emergency Care of the Cardiac Patient
  • Vascular Disorders
  • Shock
  • Medication Administration
  • Upper GI Disorders
  • Fundamentals of Emergency Nursing
  • Understanding Society
  • Adulthood Growth and Development
  • Oncologic Disorders
  • Postoperative Nursing
  • Renal Disorders
  • Microbiology
  • Intraoperative Nursing
  • Shock
  • Tissues and Glands
  • Newborn Care

Study Plan Lessons

EKG (ECG) Course Introduction
Fluid & Electrolytes Course Introduction
Respiratory Course Introduction
Electrical A&P of the Heart
Respiratory A&P Module Intro
Electrolytes Involved in Cardiac (Heart) Conduction
Fluid Pressures
Lung Sounds
Alveoli & Atelectasis
Alveoli & Atelectasis
Fluid Shifts (Ascites) (Pleural Effusion)
Gas Exchange
Gas Exchange
Isotonic Solutions (IV solutions)
Hypotonic Solutions (IV solutions)
Hypertonic Solutions (IV solutions)
Preload and Afterload
Performing Cardiac (Heart) Monitoring
Lung Diseases Module Intro
The EKG (ECG) Graph
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology for Asthma
EKG (ECG) Waveforms
Sodium-Na (Hypernatremia, Hyponatremia)
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Calculating Heart Rate
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Chloride-Cl (Hyperchloremia, Hypochloremia)
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology for Pulmonary Edema
Phosphorus-Phos
Normal Sinus Rhythm
Normal Sinus Rhythm
Respiratory Infections Module Intro
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Influenza (Flu)
Sinus Bradycardia
Sinus Bradycardia
Sinus Tachycardia
Sinus Tachycardia
Nursing Care and Pathophysiology for Tuberculosis (TB)
Atrial Flutter
Pacemakers
Nursing Care and Pathophysiology of Pneumonia
Atrial Fibrillation (A Fib)
Atrial Fibrillation (A Fib)
Coronavirus (COVID-19) Nursing Care and General Information
Premature Atrial Contraction (PAC)
Supraventricular Tachycardia (SVT)
Premature Ventricular Contraction (PVC)
Premature Ventricular Contraction (PVC)
Ventricular Tachycardia (V-tach)
Ventricular Tachycardia (V-tach)
Ventricular Fibrillation (V Fib)
Ventricular Fibrillation (V Fib)
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
Oxygen Delivery Module Intro
Hierarchy of O2 Delivery
Nursing Care and Pathophysiology of Hypertension (HTN)
Artificial Airways
Artificial Airways
Airway Suctioning
Airway Suctioning
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Respiratory Trauma Module Intro
Blunt Chest Trauma
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Cardiogenic Shock
Chest Tube Management
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Pulmonary Embolism
Respiratory Procedures Module Intro
ABG (Arterial Blood Gas) Interpretation-The Basics
ABG (Arterial Blood Gas) Oxygenation
ABG Course (Arterial Blood Gas) Introduction
ABGs Nursing Normal Lab Values
ABGs Tic-Tac-Toe interpretation Method
Acute Coronary Syndrome (ACS) Module Intro
Bariatric: IV Insertion
Base Excess & Deficit
Blood Flow Through The Heart
Bronchoscopy
Cardiac A&P Module Intro
Cardiac Anatomy
Cardiac Course Introduction
Cardiovascular Disorders (CVD) Module Intro
Chest Tube Management
Combative: IV Insertion
Coronary Circulation
Dark Skin: IV Insertion
Drawing Blood from the IV
Fluid Compartments
Geriatric: IV Insertion
Giving Medication Through An IV Set Port
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Hemodynamics
Hemodynamics
How to Remove (discontinue) an IV
How to Secure an IV (chevron, transparent dressing)
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
IV Catheter Selection (gauge, color)
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
IV Drip Administration & Safety Checks
IV Drip Therapy – Medications Used for Drips
IV Insertion Angle
IV Insertion Course Introduction
IV Placement Start To Finish (How to Start an IV)
Lactic Acid
Lung Sounds
Maintenance of the IV
Metabolic Acidosis (interpretation and nursing diagnosis)
Metabolic Alkalosis
MI Surgical Intervention
Needle Safety
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Pneumonia
Pacemakers
Performing Cardiac (Heart) Monitoring
Positioning
Potassium-K (Hyperkalemia, Hypokalemia)
Preload and Afterload
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
ROME – ABG (Arterial Blood Gas) Interpretation
Selecting THE vein
Shock Module Intro
Supplies Needed
Tattoos IV Insertion
Thoracentesis
Tips & Tricks
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
Understanding All The IV Set Ports
Using Aseptic Technique
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Vent Alarms