Thread by @TessaRDavis

Getting your paediatric patient in the right position boosts your chance of getting that cannula in first time.

Whilst we are taught how to cannulate, most of us have to learn the best positions the hard way

Here are the positions that help me get the cannula in first time.🧵👇

When we first start out, we think the position doesn't matter as long as we see a vein

It’s not until we fail multiple times we start to think about why we can't get it in

The right position depends on:

• the age of the child
• the available space
• cooperation from parents

1. Babies

I always cannulate babies while they lie on the bed.

I never do it in the parent's arms. It just isn't stable enough.

This ensures:

• The parent can be close + comfort
• I get a good view of the vein
• Someone can hold the baby's other limbs out the way

Babies: use a C shape with your hand

How do you get a good grip to hold the baby still?

A few things that helped me:

• Make a c shape with my index finger + thumb
• Position the limb with the vein in the centre of the C

This ensures stability + a good view of the vein

2. Toddlers

The hardest part of learning cannulation for me was when toddlers moved around so much that I couldn't get near a vein.

This led to distressed, sweaty toddlers, + upset parents.

Even when I got the cannula in, it often got dislodged before I taped it down.

If we use a position where the toddler straddles the parent (tummy to tummy), we ensure:

• the parent can hold the child AND hug them
• someone else can help distract the child
• we can see the vein

This way the child + parent don't need to look at what you're doing at all.

3. Older children

Have the child lying on the bed and ask them if they want to look or not.

This gets the child

• involved in the decision-making
• on board with the procedure

If they want to look, let them see. If not, you can strategically block their view.

Try these out and learn what works for you.

The best cannulators you know will also have gone through trying different positions

And they have stories of failure + triumph to prove it.

The key to all of these is to allow:

• Comfort
• Stability
• Good view
• Distraction

TL;DR - Advice on getting the best position for paed cannulation success

• Adapt to the child's age
• Have babies on the bed
• Have toddlers straddle the parent
• Lie older children on the bed + ask if they want to look
• Ensure comfort, stability, good view, + distraction

If you found this thread valuable:

1. Follow for more threads on paediatrics and learning → @tessardavis

2. Here's another thread you might enjoy on newborn examination:

https://twitter.com/TessaRDavis/status/1429319707988054016?s=20

3. Here’s the full YouTube video on cannula positioning:

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