What are the techniques for scalp vein puncture in children?

As newly graduated medical workers, we need to learn some skills. Although we have learned relevant medical nursing methods in school, we still need to practice repeatedly in practice. Some techniques are also required, such as scalp vein puncture in children. Let’s take a look at the techniques for scalp vein puncture in children.

1 Characteristics of children's scalp

The scalp veins are distributed in a network pattern, and blood can return to the heart through collateral branches in the internal jugular vein and external jugular vein. Therefore, neither antegrade nor retrograde needle insertion affects venous return. The median vein is a larger scalp vein. This vein is straight, large, non-slip, and easy to fix, but prone to extravasation. Retrograde needle insertion can overcome the disadvantage of extravasation. The superficial frontal vein and superficial temporal vein have the advantages of non-slippage, easy fixation, obvious exposure, and no extravasation. They are the best sites for scalp venous infusion, but these veins are relatively small and the technology is more difficult. The posterior auricular vein is thicker, slightly curved, easy to slide, and difficult to grasp the depth. The hair must be shaved to facilitate puncture and fixation, but due to the hyperactivity of children, it is not easy to care for them.

2 Operator’s Psychology

The operator must have good psychological quality, maintain a normal, stable and relaxed mood, communicate more with children and their families, establish a good doctor-patient relationship, and increase trust.

3 Light intensity

Generally, bright, natural light is the best. If the light is too dim, the pupil will dilate, the eyes will be easily tired and dizzy, and the blood vessels will not be clearly seen. If the light is too strong, the pupil will shrink, the eyes will be easily stinging, and the puncture will be affected. At night or in dark weather, a 100-150W lamp can be used in front of the operator, 40-50cm away from the puncture site.

4. Preparation of drug solution

Do not add liquid medicine into the liquid before the puncture is successful, so as to avoid wasting liquid medicine when exhausting air and multiple punctures, and inaccurate dosage that affects the treatment. After the puncture is successful, add liquid medicine as required by the doctor.

5 Head fixation in children

During puncture, whether the child's head is correctly fixed determines the success rate of the puncture. When fixing, the assistant or family member holds the child's zygomatic bones, cheeks and mandible with both hands, with the elbows as support points. The child's hands are under the assistant's hands. Fix the child's head and do not press on the child's body and limbs to avoid increasing resistance and making it difficult to fix.

6 Needle insertion technique

The straight puncture method is generally adopted during puncture, with the needle tip at a 10° to 15° angle to the skin. After entering the skin, the needle penetrates 0.5 to 1 cm in the skin, from shallow to deep, slowly entering the blood vessel, depending on the thickness and straightness of the blood vessel. Needle insertion is stopped when blood returns.

7 Fixing needle

In view of the characteristics of children such as hyperactivity and lack of cooperation, it is very important to fix the needle. A good fixation of the needle is conducive to nursing and smooth completion of treatment. In actual operation, it is often the case that after successful puncture, the needle is not properly fixed, resulting in fluid extravasation, and the puncture needs to be repeated. When sticking the needle, there should be no sweat stains on the skin near the needle. The first piece of tape must be firmly stuck to the needle handle, and the subsequent tapes can be stuck on this basis. The tape should not be too long or too wide, and 4-5cm×1-1.5cm is appropriate. If it is too long, it will be wasteful and unsightly; secondly, it will stick to the hair and skin and cause pain when the needle is pulled out.

8. Puncture of special children

Puncture is difficult for children with dark skin and unclear blood vessels. We must carefully identify the direction and depth of the blood vessels, have a clear idea of ​​what is going on, and use the direct puncture method to increase the success rate of puncture. Do not insert the needle blindly, which will increase the pain of the child. For dehydrated children, the blood volume is insufficient, the scalp blood vessels are sunken, and the blood return is poor. An assistant is required. Use a 5-10ml disposable syringe to draw the corresponding empty liquid into the skin puncture needle. After the needle enters the scalp skin, draw the liquid while inserting the needle. Stop inserting the needle when blood returns. While fixing the needle, push the liquid slowly to prevent the needle from being blocked by viscous blood.

What are the techniques for scalp vein puncture in children? We have learned the techniques of scalp puncture in children above. These are what we medical workers need to learn. Pediatric puncture is more difficult than adult puncture because children’s blood vessels are thinner and it is also very stressful. I hope these techniques can help more medical workers like me to become proficient.