Thursday, April 13, 2006

IV sites

The largest, most stable veins in infants are in the scalp. Lots of babies are virtually bald, too, making those veins even more inviting when you’re looking for a place to put the IV that your tiny patient needs RIGHT NOW. Unfortunately, parents often find scalp IVs rather intimidating. This leads to somewhat less than positive interactions at times. Usually the parents will take my word that it not only is in the baby’s best interest, but that there really isn’t another option. Other times, I’m just as happy to leave those discussions to the physicians.

One night I was called to the pediatric unit to place an IV in one of their smaller patients. The only veins I could find were in the scalp. The patient’s nurse wanted to ask the mom’s permission prior to placing the IV in the scalp. I’m generally in favor of involving parents in decisions – when it’s appropriate. This time there was only one acceptable answer. No point in presenting options that don’t exist. Mom didn’t seem upset when I explained why I had chosen that scalp vein and assured her that it wasn’t causing the baby any pain. I headed back to the NICU and missed Act Two in which the baby’s father arrived and demanded that we “take that needle out of my baby’s brain.” He wouldn't listen to the baby’s nurse, but the pediatric resident was able to convince him that it 1) wasn’t in the brain, and 2) wasn’t coming out until the baby was better hydrated.

Sometimes we have issues in the NICU too. The day shift nurse had placed the scalp IV in my patient. Mom and grandfather had been in and had seen it. Nobody said anything to the day shift nurse, so we were caught off guard when mom phoned that evening. Fortunately for me, one of my favorite pediatric surgeons happened to be making rounds on his NICU patients when mom called. He asked to speak with her and she apparently passed the phone to her father. This is the half of the conversation I heard:

“Actually, there’s no needle, just a flexible tubing.”
.....

“No, it’s not in the brain.”
.....

“The skull and some tough membranes are between...”
.....

“Those veins are the largest and most stable veins. The IV will stay in longer there.”
.....

“I told the nurse to put the IV in the baby’s head”
.....

“When my grandson had surgery, I insisted that they put the IV in his head.”



I don’t know if his grandson ever had surgery, but this seemed to be the answer that satisfied the baby’s grandfather as the conversation went on from there to other details of the baby’s condition. The statement that most impressed me was his claim that he had told the nurse to put the IV in the head. I doubt he’d had any such conversation, although he would have if she thought she needed to ask. We loved him because he cared for his patients so much – but also because he made the nurses feel like a valued part of the team. He has since retired. I am happy for him, but we all miss him.

3 comments:

Alice said...

He sounds like a great physician, backing the nurses up well. I know the residents always appreciate it when the attending takes the trouble to stand up for them.

Suz said...

Wow, he sounds like a great doc. In my career I've worked with a few exceptional docs like that - not enough, really! Wish they were all like this!

Judy said...

A great physician and a true gentleman. I don't know anyone who doesn't respect him.