By far the most frequent procedure I help with in the ED is the placement of peripheral IVs. This is also a poke procedure, so it brings up a lot of fears from quite a few children. I don't actually have a "prep kit" for IV starts, mainly because I use the materials so frequently that I just make sure I always have things in my pockets so I am ready to be pulled into one whenever. At minimum I always have three things.
1. IV catheter: I wear one on my badge so that I always have it handy and don't lose it. Not only is in convenient to always have on hand that way, but I find that it also helps demonstrate how 'safe' IVs are since the kids know I wear it all the time. Depending on the patient's age I will give them to choice to see and touch the catheter, for others I will show them as a natural part of my preparation. Ironically enough, I have only ever had physicians notice it and ask if I have the needle in it! If a patient does notice it I tell them its a medicine straw that I use to teach kids. If that patient doesn't need an IV I make sure to tell them that, and then I continue on talking about what I originally came to the room to do.
2. Tourniquet: I keep this part of the preparation materials in the pocket of my pants. Before I show the tourniquet to patients I have a brief conversation with them about their veins (blue lines). When introducing the tourniquet I describe it as being like a rubber band and mention that ours is blue in color. This is the preparation materials that most kids enjoy manipulating, they will stretch it pretty far sometimes! I tell kids that sometimes our veins like to play hide-and-seek, so the nurses use the tourniquet to find their veins better. I personally don't like describing the sensation of a tourniquet as a "hug", those are supposed to be comforting, so instead I say it gives their arm a squeeze.
3. Distraction: I like to use lots of things for distraction, but when if I get pulled into a procedure and don't have any of my other materials with my I keep an iSpy card on my ID badge. Admittedly this card doesn't work well for all situations, but in a pinch it is sometimes better than nothing. If I don't have any other materials and the patient is too young to play iSpy most often I like to sing with them or to them. In a perfect world I would always have an iSpy book, light spinner, or bubbles on me to aid in the distraction process, but it is nice to know that I am never walking into a room empty handed.
I am lucky to work with nursing staff that utilize various techniques for pain management as well. The nurses are usually, not always because sometimes time won't allow, able to give me the pain management method being offered to show, allow manipulation, or demonstrate before we begin. The most common things we use are vapocoolant sprays (cold spray), Buzzy, and when time allows the Synera patch. That's all that I utilize for my IV preps, there isn't much time for a lot of extra stuff to be used! What things do you add to your prep?
-K
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