We were pleased that Amanda Ullman took up our offer to speak at DFTB after the great post she and the Vascular Access Management Service wrote for us on management of paediatric central access devices. This talk comes complete with trigger warnings. We’ve all been in the situation when we have been confronted with doughy armed toddlers and no sign of a vein in site. The parents, and that patient, are relying on you to get it right.
Given the prime directive of physicians of Primum Non Nocere (First Do No Harm) it is worth considering if we should be cannulating the child in the first place. In a study by Holloway et al. (2017) they found that 22% of PIVCs were unused after insertion. With a success rate of around 60% in our well children, we really to sway the odds further in our favour.
But is also worth considering the flipside – cannulation may be less painful than heel prick for blood sampling in neonates. Amanda asks us to consider if you are the right person to put in that cannula. Should you just ‘give it a go anyway’? Have you been up half the night and can barely focus? Have you just missed you last six cannulae and have something to prove?