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girl with IV being comforted by dad

IVs and You: Don’t Get Stuck Not Knowing the Lowdown

Are you one of those people who hates going to the dentist because of the sound of the drill? Can’t tolerate that “hospital smell”? Do you rip the paper examination gown every time you try to put it on (backwards)?

Well, I’m sort of with you. As odd as it sounds, I’m more than a bit terrible when it comes to facing needles on my own. When I worked in the Emergency Department at a large, urban children’s hospital one of my faculty colleagues would have to chaperone me to get my flu shot because I would almost PASS OUT. Absurd. Without blinking an eye, I’ve done a large number of medical procedures throughout my career that can resolutely be placed in the “gross” category. And yet, I need a chaperone to get my own small injection. In fact, when I had my 2 kids and an IV was required, you would have thought that the highly technical microvascular surgical team was necessary, since I acted like this simple procedure was more complex than cutting-edge robotics.

So, facing this head-on, today we dissect that squirrelly, anxiety-producing procedure commonly known as the IV line.

The IV Procedure

The abbreviation IV stands for intravenous (25 cents!), with intra meaning “in” and venous representing “vein.” The IV equipment itself consists of 2 parts: the needle and the catheter. The catheter is a flexible, plastic straw that fits like a sheath around the needle. This is the only thing that stays in the body after the placement is complete.

Once a tourniquet is applied and a suitable vein is located, the needle penetrates the skin. When it accesses the vein, a confirmatory flash of blood is seen in the clear plastic hub at the top. The needle is then withdrawn while the catheter is advanced further into the vein until the needle is removed completely, leaving just the catheter in the vein. It is then either capped off or attached to tubing that can contain medicine and/or fluids in the line. The catheter is secured to the outside of the skin with a clear dressing and/or medical tape without obscuring it completely, so the site can be regularly examined.

Sounds simple enough, right? 

All you tough grown-up folks reading this are thinking “THIS IS NO BIG DEAL.”

Ok, imagine doing this procedure on a tiny premature infant. Or a squirming, howling toddler. Or a child with chronic illness who has had so many IVs that her veins are scarred down and difficult to access.  A bit of a game changer from the typical adult garden hose veins.

There’s no real magic in successful IVs, just practice and experience.  Well, and maybe a bit of voodoo, like always tearing off the right amount of tape BEFORE you even start. Some people repeatedly tap the skin after the tourniquet is applied to encourage the vein to “stand out.” Others use fancy equipment to identify the right location. Once the IV is in, it really shouldn’t hurt. Sometimes people describe being able to feel the cool temperature of fluids going in through the catheter. If there is pain at the IV site, then it should be assessed right away to make sure it is still patent and freely flowing.

Why Is an IV Necessary?

Whatever the ritual, it’s always acceptable to ask WHY you or your child is getting this IV. Sometimes an IV will be placed at the same time a blood sample is drawn “just in case” IV medicines or fluids might be needed. If blood is being drawn anyway, it saves another needle stick if the sample can be obtained at the same time as the IV insertion. Other times, there may be a concern about a potential deterioration in a patient’s condition, so being ready to escalate intervention is simply being cautious and prepared. You should have a general understanding of why the IV is being established. Most of the time an IV is placed when medicines or fluids need to be delivered to the body quickly since IV formulations don’t need to be digested and absorbed in the gastrointestinal system.

Common reasons for getting an IV…

Useful Tricks of the Trade

Have YOU had an IV? Or your child? What was your experience like? I’m secretly looking for a few of you to be as much of a weenie as I am about this and come clean about it, but in the spirit of sharing all the knowledge, I welcome any and all stories, comments, and anecdotes!

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About the Expert

headshot of Dr. Christina Johns

Dr. Christina Johns is a nationally recognized pediatric emergency physician and Senior Medical Advisor at PM Pediatric Care. An official spokesperson for the American Academy of Pediatrics, she is board-certified in both pediatrics and pediatric emergency medicine. With extensive media experience, the proud mom of two teenagers shares over 20 years of pediatric expertise with patients and families everywhere. Follow Dr. Johns for more insights on children’s health!