Cannulating children
Having to cannulate a child often fills doctors with
dread. There is an angry looking dad, an anxious mum, and a screaming child
you cannot keep still. Here are some tips to stop your blood pressure
hitting the roof.
- Play with the child
while choosing a few good veins for application of a local anaesthetic
cream (such as Ametop or Emla). Then, cover the cream with an adhesive
plastic dressing and a bandage. Otherwise, you'll return to find the
cream smeared everywhere or, worse, licked off
- Wait long
enough for the cream to work - but not so long that the skin becomes
red and swollen. (Ametop 30 mins, Emla 1 hour)
- The
child's bed space should be a "safe place." Don't
cannulate them there. Instead, take them to a quiet but colourful room with
their parents, a nurse, and, if possible, a play specialist. Play
specialists are masters in the art of distraction, which will make your
life so much easier. They may even have time to cannulate teddy beforehand
- Meanwhile, the
nurse will be supporting the parents, holding the child's limb still,
and acting as a tourniquet, so all you have to do is cannulate
- Positioning is
crucial. Bear hugs work well with small children. They sit astride their
parent, while you sit behind mum or dad and take the relevant limb
- Use the correct
size cannula - generally yellow or blue. Make sure all your equipment
is within arm's reach - asking a two year old to keep still while
you get a flush won't work
- Fix it well.
Children are incredibly skilled at getting rid of things they don't
like. Plenty of tape, a splint, and a bandage is not overdoing it, but try
not to obscure the entry site
- If it still
goes horribly wrong, don't despair. But do remember that in this
situation the adage "try, try, try again" does not
apply - ask for help
Helen F J Miles, senior house officer in paediatric haematology/oncology
Email: helenmiles76@hotmail.com
Meghana S Gholkar, senior house officer in paediatric haematology/oncology, Birmingham Children's Hospital
studentBMJ 2005;13:177-220 May ISSN 0966-6494
