Difficult pediatric peripheral venous access is a common and frustrating problem for research clinicians and participants alike. Multiple venous access attempts increase participant pain and anxiety, and may threaten commitment to the research protocol.
Jean Addis, RN, Patient Care Manager and Jennifer Puck, MD, Medical Director Pediatric Clinical Research Center (CRC), Clinical Research Services, UCSF CTSI
Tricky Veins: Approach to Difficult Venous Access Jean Addis, RN, Patient Care Manager and Jennifer Puck, MD, Medical Director Pediatric Clinical Research Center (CRC), Clinical Research Services, UCSF CTSI Bringing better health to more people more quickly! Current Evidence- Methods Based Practice Implemented Suggests: •Create a list of returning • Warming extremities participants with challenging • Assuring oral hydration veins • Utilizing visualization devices •Flag returning appointments • Applying topical anesthetic for these participants and • Positioning the extremity below develop staff action plan for the level of the heart vascular access • Properly applying the tourniquet •Educate participants and Challenge: family on methods to • Preventing vein rolling by Tricky Veins holding tension below needle increase first time successDifficult pediatric peripheral insertion site rates and enlist their Resultsvenous access is a common cooperation with extremity • Involving Child Life Services Mos 11 Aug Sep Octand frustrating problem for warming, hydration, topical play therapists for distractionresearch clinicians and anesthesia, and distraction and psychological support Phleb 92% 98% 95%participants alike. Multiple techniques • A PCRC nurse participates onvenous access attempts •Limit attempts to one per UCSF Benioff’s Children’s PIV 81% 90% 83%increase participant pain and clinician, with a maximum of Hospital Vascular Accessanxiety, and may threaten four attempts, and keep Committeecommitment to the research investigator/ studyprotocol. coordinators informed Conclusion Baseline Rate Identified •Engage Child Life Services To validate investigators’ Increased communication Introduction •Place the following Label on perceptions of excess between patient/family andInvestigators conducting the back of appointment unsuccessful vascular access care givers for early card:outpatient studies at the attempts the PCRC tracked recognition of “tricky veins”Pediatric CRC brought to our showed a sustained number of attempts perattention their perception that improvement for successful participant for a one monthsome participants were PIV insertions and patient period. First stick success rates  Drink a lot of water nightexperiencing a large number satisfaction. However, obese were 92% for phlebotomy and before & day of yourof vascular access attempts. patients continue to be an 81% for peripheral IV placement, apt. No soda!A clinical research review of issue. We recommend training significantly better than published  Bring items like movies,literature reported only 53% staff to utilize ultrasound research statistics. However, books, music, or stuffedto 76% success rates for first some patients were consistently techniques for PIV access ontime pediatric cannulation. animal to help you relax. obese participants. requiring multiple attempts.  Ask for our Child Life Specialist to help distract Goals during procedure. 1.Implement strategies to obtain  San Francisco is cold so first stick success rates for all bring a warm jacket or phlebotomy to greater then 90%. blanket to stay warm. 2.Improve the experience of Being cold makes veins patients with ‘tricky veins.’ disappear