Difficult pediatric peripheral venous access is a common and frustrating problem for research clinicians and participants alike. Multiple venous access attempts increase participant pain and anxiety, and may threaten commitment to the research protocol. Jean Addis, RN, Patient Care Manager and Jennifer Puck, MD, Medical Director Pediatric Clinical Research Center (CRC), Clinical Research Services, UCSF CTSI

1. Tricky Veins: Approach to Difficult Venous Access
Jean Addis, RN, Patient Care Manager and Jennifer Puck, MD, Medical Director
Pediatric Clinical Research Center (CRC), Clinical Research Services, UCSF CTSI
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Current Evidence- Methods
Based Practice Implemented
Suggests: •Create a list of returning
• Warming extremities participants with challenging
• Assuring oral hydration veins
• Utilizing visualization devices •Flag returning appointments
• Applying topical anesthetic for these participants and
• Positioning the extremity below develop staff action plan for
the level of the heart vascular access
• Properly applying the tourniquet •Educate participants and
Challenge: family on methods to
• Preventing vein rolling by
Tricky Veins holding tension below needle increase first time success
Difficult pediatric peripheral
insertion site rates and enlist their Results
venous access is a common cooperation with extremity
• Involving Child Life Services Mos '11 Aug Sep Oct
and frustrating problem for warming, hydration, topical
play therapists for distraction
research clinicians and anesthesia, and distraction
and psychological support Phleb 92% 98% 95%
participants alike. Multiple techniques
• A PCRC nurse participates on
venous access attempts •Limit attempts to one per
UCSF Benioff’s Children’s PIV 81% 90% 83%
increase participant pain and clinician, with a maximum of
Hospital Vascular Access
anxiety, and may threaten four attempts, and keep
Committee
commitment to the research investigator/ study
protocol. coordinators informed Conclusion
Baseline Rate Identified •Engage Child Life Services
To validate investigators’ Increased communication
Introduction •Place the following Label on
perceptions of excess between patient/family and
Investigators conducting the back of appointment
unsuccessful vascular access care givers for early
card:
outpatient studies at the
attempts the PCRC tracked recognition of “tricky veins”
Pediatric CRC brought to our showed a sustained
number of attempts per
attention their perception that improvement for successful
participant for a one month
some participants were PIV insertions and patient
period. First stick success rates [] Drink a lot of water night
experiencing a large number satisfaction. However, obese
were 92% for phlebotomy and before & day of your
of vascular access attempts. patients continue to be an
81% for peripheral IV placement, apt. No soda!
A clinical research review of issue. We recommend training
significantly better than published [] Bring items like movies,
literature reported only 53% staff to utilize ultrasound
research statistics. However, books, music, or stuffed
to 76% success rates for first some patients were consistently techniques for PIV access on
time pediatric cannulation. animal to help you relax. obese participants.
requiring multiple attempts.
[] Ask for our Child Life
Specialist to help distract
Goals during procedure.
1.Implement strategies to obtain [] San Francisco is cold so
first stick success rates for all bring a warm jacket or
phlebotomy to greater then 90%. blanket to stay warm.
2.Improve the experience of Being cold makes veins
patients with ‘tricky veins.’
disappear