Scalp Vein Catheterization
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Vascular access is an important, sometimes critical, step in the care of sick infants and children. Peripheral vascular catheterization provides a direct route for administration of fluids and medications. Many anatomic sites are available for intravenous (IV) catheterization, with peripheral sites being the most common and most readily available. For more information, see Axillary Vein Catheterization.
Placing an IV line into a peripheral vein in a small child or infant can be a difficult task, for many reasons. Small children and infants have smaller peripheral veins, they may have more subcutaneous fat, they are prone to vasoconstriction, and they are much less likely to remain motionless and cooperative during a painful procedure than adults. The scalp veins provide a secondary option for peripheral intravascular access in small children and infants because of minimal subcutaneous fat and less movement and the lack of a flexible joint; this reduces the likelihood of dislodging the catheter, which is common with IV catheters placed in the arms or legs.
Scalp vein catheterization is indicated in any patient who requires intravascular access for the administration of fluids or medications.
The decision to attempt access via one of the scalp veins should be based on inspection or palpation of various sites. Although the scalp veins provide certain advantages, the best site at which to attempt access is whichever vein the clinician feels offers the greatest chance for successful catheterization on the basis of his or her ability to visualize or palpate the vessel. Using scalp veins can also help preserve the vessels of the arms and legs for peripherally inserted central catheters. [1]
Scalp vein catheterization is often considered only after attempts to insert a catheter at other peripheral sites have failed.
Attempting IV access near sites of superficial skin injury or infection should be avoided. [2]
DeLemos C, Abi-Nader J, Akins PT. Use of peripherally inserted central catheters as an alternative to central catheters in neurocritical care units. Crit Care Nurse. 2011 Apr. 31 (2):70-5. [Medline].
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Means SW, Spampinato MV, Rao AG, Hill JG. Preterm infant with subdural hematoma from malpositioned scalp intravenous catheter. Adv Neonatal Care. 2011 Aug. 11 (4):251-4. [Medline].
Leick-Rude MK, Haney B. Midline catheter use in the intensive care nursery. Neonatal Netw. 2006 May-Jun. 25 (3):189-99. [Medline].
Gonzalez R, Cassaro S. Percutaneous Central Catheter (PICC). Treasure Island, FL: StatPearls; 2018. [Full Text].
Wang XJ. Preventive effect of dexamethasone solution pre-treated catheter on PICCinduced phlebitis. Biomed Res. 2017. 28 (12):[Full Text].
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McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air Embolism: Practical Tips for Prevention and Treatment. J Clin Med. 2016 Oct 31. 5 (11):[Medline]. [Full Text].
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Callejas A, Osiovich H, Ting JY. Use of peripherally inserted central catheters (PICC) via scalp veins in neonates. J Matern Fetal Neonatal Med. 2016 Nov. 29 (21):3434-8. [Medline].
Ethan Bergvall, MD Chief Resident, Department of Pediatrics, Tripler Army Medical Center
Ethan Bergvall, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.
Taylor L Sawyer, DO, MEd, FAAP, FACOP Associate Professor of Pediatrics, University of Washington School of Medicine; Director, Neonatal-Perinatal Fellowship, Seattle Children’s Hospital
Taylor L Sawyer, DO, MEd, FAAP, FACOP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Medical Association, American Osteopathic Association, Association of American Medical Colleges, International Pediatric Simulation Society, Society for Simulation in Healthcare
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Laurie Scudder, DNP, NP Nurse Planner, Medscape; Senior Clinical Professor of Nursing, George Washington University
Disclosure: Nothing to disclose.
Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society
Disclosure: Nothing to disclose.
The authors wish to thank the skilled nurses of the neonatal and pediatric intensive care units at Tripler Army Medical Center who make so many things possible.
The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
Scalp Vein Catheterization
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