Peripheral IVs and Their Use in Caring for Premature Babies

Peripheral IVs and Premature Infants

An IV in a preemie’s foot.
An IV in a preemie’s foot. AndyL/Getty Images

What Is a Peripheral IV?

A peripheral IV, often known to patients as simply an IV, is a short, thin, plastic tube called a catheter. Peripheral IVs are used to deliver fluids, parenteral nutrition, medications and blood products to premature babies who have immature digestive systems and are unable to suck, swallow and breathe normally or who require medications that can only be given directly into the bloodstream.

In a process known as peripheral venous cannulation, peripheral IVs are inserted using a needle that is removed from the skin once the catheter is in the vein correctly. In premature infants, IV lines are commonly placed in the hands, arms, feet, or scalp. The peripheral IV is connected to a small plastic tube that connects to an IV bag.

What Is the Procedure for Placing a Peripheral IV?

Your nurse or doctor will:

  • Clean the skin
  • Place the catheter with a needle on the end through the skin into the vein.
  • Remove the needle once the peripheral IV is in the proper position, leaving the catheter in the vein.
  • Secure the catheter with a sterile, clear polyurethane dressing.

Because premature infants have fragile veins, peripheral IVs usually need to be replaced every 1 to 3 days, which can help reduce the risk of infection. In addition, they may stop working after only 1 or 2 days, in which case they will be replaced.

Risks and Complications of Peripheral IVs

Peripheral IVs can be more difficult to place in infants--and especially premature infants--compared with adults for numerous reasons. Infants have smaller peripheral veins, often have more subcutaneous fat, their veins are prone to constriction, and they are less likely to remain still and cooperative during discomfort.

All of these factors can be even more pronounced in premature babies, making it even more challenging to place a peripheral IV.

In some cases, the procedure cannot be completed, and another therapy may be needed such as a percutaneously inserted central catheter (PICC line). These are long, thin, plastic tubes that travel from a vein in an arm or leg into one of the large veins near the heart.

Complications of peripheral IVs are rare, but include:

  • phlebitis (inflammation of a vein)
  • cellulitis (a potentially serious bacterial skin infection)
  • sepsis (a whole-body inflammatory response to an infection)
  • tissue necrosis (death of tissue)
  • air embolus (incorrect priming)

In addition, sometimes, a peripheral IV will dislodge from the vein, and fluid from the IV can leak into the body, known as an "infiltrate." When this happens, the IV site may appear puffy and red. In some cases, an infiltrate may cause the skin and tissue to become very irritated and cause a tissue burn, depending on the medication being administered.

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