If you’ve ever tried to insert an intravenous line before, you know how difficult of a task it can be with a child. Adults usually have thinner skin and most of the time have (not always) less fat on their arms. Infants and toddlers have lots of pudge on their arms and seeing a good vein is usually difficult and often impossible. The nurses who are really good at starting IV lines – the ones that everyone in the hospital calls in a pinch – have their little tricks for getting IVs in place.
Often the veterans know that you can’t always go by sight. Sometimes veins are deep enough below the skin that you can’t see them, but you can feel them. When the hospital staff ties the tourniquet around your arm and starts prodding you with their fingertips, they’re seeing if they can feel any of the veins. Almost like the way a safecracker feels for the tumblers in the safe to drop when turning the dial.
When the veins are especially difficult, one trick that many providers use is to remove the fingertip of of the index finger of one of the rubber gloves, put a little betadine (disinfectant) on the exposed finger tip, and use that finger to palpate for a vein.
A mother who worked as a phlebotomist at another hospital (and who was badmouthing that hospital to our staff) brought her young child in for evaluation of a high fever. The doctor working that night ordered some blood tests and some IV fluid. One of our best nurses pulled the finger off the tip of the glove, put a little Betadine on her fingertip, and began palpating the pudgy kid’s arm. Immediately, the mother whipped out her cell phone and started texting someone.
No one thought much about it until the child’s grandmother called the emergency department and said she received a text message that the nurse was performing an “illegal procedure” by pulling the fingertip off of the glove.
Fifteen yards, repeat first down.
The nurse was trying to avoid poking your kid a couple dozen times before having to insert an intraosseous line. Next time, we’ll keep the fingers on the gloves. No problem.
Sometimes we just can’t win.