They will have to hold the child (and limb) tight, pinned against some immovable object. Holding at a joint will not work. Two hands will probably be needed which is why everything must be ready and within arms reach.
3. Get comfortable & calm, preferably seated.
4. Find your vein
Tourniquet on.
Limb dependent.
Tap over the vein
Warm flannels may be helpful
Skin traction along the line of the vein will help immobilise it
(not so much as to collapse it)
5. Put the cannula in the vein
If at first you don't succeed
If you are still calm try again.
If you are rattled go away and come back an hour later
Get someone else
Paedia-tricks
Let the child know exactly what you are going to do before each step.
Let them feel your confidence. Don't stuff them around and don't let yourself be stuffed around.
Parents are optional. Sometimes they are helpful sometimes they are not and there are no simple rules. If the child is less than 1 year old you are all probably better off without them.
EMLA needs to be on for at least ONE hour
Tape under the cannula, then tape over the cannula, to stop it flexing back on the skin
Where to look for veins
Limbs
The forearm vein is not as useful in children as it is in adults
Lateral aspect of back of hand
Wrist is very painful and does not last for long
Lateral aspect of the foot
Scalp veins
Don't hit the artery...it is bad for the brain!
The artery is usually pulsatile and tortuous
Shave the head or you will never stick it down
External jugular
Can be very hard to immobilise
Long saphenous
A personal favourite
Reasonably constant on the anterior aspect of the medial malleolus
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