Ever had a sick baby that you need to get IV access on quickly? I recently had an underweight, dehydrated febrile 2 month old, who clearly needed a prompt IV for bloods and antibiotics/fluid. They were dark-skinned and also had pretty bad scabies, making the skin very rough, so it was essentially impossible to feel or see a vein. On paper you’d say “just go for the I/O”, but this baby was alert, still taking small breast feeds and despite the description did not seem shocked, so I wanted to try for peripheral IV access first. So how do you find a vein?
Some paeds ED’s or paediatric wards will have special transilluminators with red LED’s that you can use to help you find a vein (such as the Wee Sight Transilluminator ). Unfortunately I couldn’t access one of these, so thought I’d have a go with a standard piece of ED equipment – the otoscope, and got surprisingly good illumination of the hand. (click on image to enlarge)
In this pateint it revelaed a lack of peripheral veins worth trying, (indicating a degree of peripheral shutdown that raised my level of concern for the child) so we ended up going for a cubital fossa “blind stab” which worked, (and we were one step away from an I/O!), but I was pleasantly surprised at the level of illumination provided by the standard bedside bit of ED kit. Worth a try if you’re struggling with a peripheral IV in a baby. Just be aware the light does get quite warm, so make sure you don’t hold it there too long, as it may start hurting (not sure it’s hot enough to burn the skin, but be careful nonetheless).
TIP: turn the room lights off to get maximal contrast.