Commonly used sites for venipuncture in children

The main purpose of venipuncture is to provide infusion. Adults usually perform venipuncture on their hands. However, since the blood vessels on children's hands are relatively thin, they are not easy to observe. Therefore, children usually do not choose their hands for venipuncture. However, when children get sick, they are very serious and can only be treated by infusion. So what are the common sites for venipuncture in children?

Reasonable selection of site and vein for venipuncture in children

Choose different puncture sites according to age. For children from newborns to 2 years old, scalp veins should be selected, and for children older than 2 years old, limb veins should be selected. For children who need multiple infusions, veins should be selected from the distal end.

The scalp veins for children are generally the median frontal vein, the superficial temporal vein, and the posterior auricular vein. When selecting a vein for puncture, it is necessary to distinguish it from the artery.

1. Superficial temporal vein: located on both sides of the temporal region, it collects blood from the scalp and flows into the posterior facial vein.

2. Posterior auricular vein: It originates from the venous plexus at the back of the skull, flows downward into the external jugular vein, and runs along with the artery of the same name behind the auricle.

3. Frontal vein (supratrochlear vein): It originates from the venous plexus at the coronal suture, descends vertically along the surface of the frontal bone and merges into the anterior face vein. Scalp vein puncture should be performed along the vein in a centripetal direction.

The main superficial veins of the upper limbs are the cephalic vein, basilic vein, and median cubital vein.

1. Cephalic vein: It originates from the venous network above the radiocarpal joint on the back of the hand, turns to the flexion surface of the forearm, ascends subcutaneously along the radial side of the forearm, anastomoses with the basilic vein through the middle cubital vein at the antecubital fossa, rises along the lateral groove of the biceps brachii, and is injected into the subclavian vein or axillary vein, collecting the superficial veins on the radial palm and back of the hand and forearm.

2. Basilic vein: It starts from the ulnar side of the venous network on the back of the hand, goes to the flexor side of the forearm, receives the median cubital vein at the antecubital fossa, goes up along the medial groove of the biceps brachii, and is injected into the brachial vein or flows upward along the brachial vein into the axillary vein. It houses the superficial veins of the hand and ulnar side of the forearm.

3. Median cubital vein: short and thick, with many variations, usually connecting the basilic vein and cephalic vein in the cubital fossa. In clinical practice, this is often used for blood draw or intravenous injection.

The major superficial veins of the lower limbs are the greater saphenous vein and the lesser saphenous vein.

1. Great saphenous vein: It is the longest and largest subcutaneous superficial vein in the body. It starts from the inner side of the dorsal venous arch of the foot → about 1 cm in front of the medial malleolus, ascends along the inner side of the calf along with the saphenous nerve → the inner side of the knee joint, bypasses the posterior side of the medial femoral condyle → the inner side of the thigh → the front of the thigh → passes through the ethmoid fascia 3-4 cm below and outside the pubic tubercle until it merges into the common femoral vein in the groin.

2. The small saphenous vein ascends along the posterior and lateral sides of the lower leg on the lateral side of the dorsum of the foot to the back of the knee joint and merges into the vein.

Scalp venipuncture in children

Pediatric scalp vein puncture is a common and basic nursing operation in pediatrics. Its level is directly related to the quality of hospital services, the recovery of children and the nurse-patient relationship. Because the blood vessels in children's scalp are thin and curved, the straighter blood vessels are short and not full enough, and children are restless, puncture is difficult and hard to fix, resulting in a high puncture failure rate. Below, an expert from the Nursing Department of Zhangzhou Zhengxing Hospital will explain pediatric scalp vein puncture.

(I) Preparation before puncture

1. Preparation of the patient and parents

It is necessary to do a good job of parental work in advance and gain their understanding and cooperation. Before the puncture, inform the child's parents not to feed the child milk or water to avoid nausea and vomiting caused by crying during the puncture, which may lead to suffocation and accidents. At the same time, parents should be informed of how to help restrain the child's head and legs.

2. Nurse's preparation

When the child is crying, the child's parents are anxious and feel sorry for their child's easily excited emotions, which will interfere with the nurse's operation. Therefore, as a nurse, you must understand the parents' mood and maintain a stable mental state during the operation, concentrate, remain calm, take your time, and eliminate distractions. At the same time, prepare all your items.

3. Environmental preparation

The intensity, brightness and irradiation angle of the light during puncture directly affect the success rate of puncture. Too strong light can cause the pupil to shrink, while too weak light can cause the pupil to dilate. Therefore, bright natural light with appropriate brightness is the most ideal light, which can make the veins clear and reduce the operator's eyes fatigue. In a dimly lit room, rainy weather, or at night, you can only use a fluorescent lamp. Place the bulb above the operator's left front, 40-50 cm away from the puncture vein. In short, no matter which light source is chosen, the operator's body and hands should not block the light at the puncture site.

(II) Selection and precautions during puncture

1. Choice of blood vessels

Scalp vein puncture in children is more difficult than puncturing veins in other parts of the body because children are less cooperative, so the choice of vein is of great significance. From the perspective of overall anatomy, the median frontal vein on the head is fixed and not prone to sliding. It is easy to fix after successful puncture, making it the preferred site for scalp vein puncture in children. The superficial temporal vein and posterior auricular vein located in front and above the tragus are suitable for intravenous infusion.

2. Needle selection

The needle size selection principle is based on the thickness and depth of the vein. Generally, a 4.5-5.5 gauge needle is more suitable for scalp veins.