Thread by @TessaRDavis

Knowing how to choose the best vein for our paediatric cannulas unlocks the key to success.

Most of us have to learn this by watching others, and learning from our own failures.

Here are my tips on how to choose the best site to help you get that cannula in first time.🧵👇

When we first start out, we think just getting the cannula in is what matters.

After our cannulas get blocked or fall out, we start to think about why they don't work for as long as we want

The best vein is:

• juicy
• easily visible/palpable
• straight
• in a good location

The arm.

The best option is the arm + ideally it should be away from a joint.

Why do we want it away from a joint?

• It's really annoying for the child every time they bend their arm
• It's more likely to get blocked
• It's more likely to fall out

Back of the hand

If you can see the vein here you'll be on the path to a quick + slick cannula.

In babies they are often easily visible, but this can get trickier in chubby toddlers.

Also, those with kidney disease need arm veins protected for a fistula so the hand can be good

Ante-cubital fossa.

I find these really hard to cannulate in younger children.

• I can't see the vein
• It's hard to immobilise

In older children it works well (+ an ultrasound can help).

It's easy to forget though how annoying it is for patient to have a cannula here.

Foot.

This can be an easy option, but remember:

• In a mobile child it affects their ability to move around
• They have a higher fail rate
• They have a higher complication rate

As we continue to gain experience, we realise that at times this is our best chance of success

Back up options.

There are always times where none of these options are feasible. Consider ultrasound to help.

Scalp veins are a great 'wild card' in babies:

• shave the scalp
• choose a visible vein

Importantly, make sure the cannula always points towards the heart.

Tip #1: Think about why the cannula is needed.

I eventually learned that not all cannulations are the same.

Consider: is the cannula just needed for an hour or is it needed for days?

A foot or a joint would be ok for a quick procedure, but it won't be ideal for longer use.

Tip #2: Does the child have sensory needs?

Parents of children with sensory processing disorders or learning disabilities may tell us it's better in the foot.

This could be because it will:

• Be less noticeable
• Won't bother them as much
• Be harder for them to pull it out

Tip #3: The family knows best

This is the most important advice of all.

If we can, give them the choice.

• Consider hand dominance
• Be mindful of mobility
• Those with frequent cannulations know what works

Asking boosts our chance of success + gets the family on board.

The hardest part of learning cannulation for me was in chubby toddlers where you can't see a vein.

It took me years to realise the basilic vein was right there waiting.

It's so juicy that once you hit it, it threads like a dream.

Slowly I improved + now it's my favourite spot

TL;DR - Tips on choosing the best vein for paediatric cannulation

• Consider the arm, hand, antecubital fossa, foot
• Have a backup plan (scalp vein + using ultrasound)
• Think about how long it's needed for
• Be aware of sensory needs
• Ask the family where they'd prefer

If you found this thread valuable:

1. Follow for more threads on paediatrics and surviving medicine → @TessaRDavis

2. Here’s another similar thread you might enjoy:

https://twitter.com/TessaRDavis/status/1436935701946380290?s=20

3. Watch the full YouTube video:

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