Equipment

Having the appropriate equipment is of utmost importance for successful scalp vein catheterization. Minimum equipment required includes the following:

Elastic band tourniquet
Adequate lighting
Antiseptic wipes
Syringes, filled with 0.9% saline, for flush
Tape for securing the intravenous (IV) catheter and tubing
Appropriately sized IV over-the-needle catheter - Catheters of 22-24 gauge are frequently selected for use in small children and infants and are usually an appropriate choice for the scalp veins

Anesthesia

Use of anesthesia is generally not indicated. Topical anesthesia may be considered with the use of a lidocaine cream or patch, but these require at least 20-30 minutes to be effective. For more information, see Anesthesia, Topical.

Positioning

The patient should be lying in a supine position with his or her head turned so that the desired scalp vein is visible and readily accessible. The clinician should be located at the head of the bed with the patient’s feet extending away from the clinician. A slight head-down position may facilitate catheterization by distending the veins of the head and neck. To minimize the risk of injury to either the patient or the clinician, care should be taken to ensure that the patient is appropriately restrained.

Technique

Media Gallery

Common sites of insertion for peripheral scalp vein catheterization include frontal, posterior auricular, and superficial temporal veins.
Elastic band is used as tourniquet to distend scalp veins. Small piece of tape attached to elastic facilitates removal.
Catheter-over-needle device is inserted at 30-degree angle to skin surface, with needle pointing in direction of blood flow; flash of blood is seen in hub as needle enters lumen of vein.
Once needle has entered vein, catheter-over-needle device is (1) lowered so that it is just off skin surface, then (2) advanced slightly further to ensure that both needle tip and catheter tip are in vessel lumen.
When both needle tip and catheter tip are inside vessel lumen, catheter is advanced forward (1) off needle and further into vein.
IV extension tubing (preflushed with normal saline) is attached to catheter after removal of needle. Saline-filled syringe is used to gently flush catheter while observing for signs of infiltration.
Catheter is secured with clear plastic dressing. Folded piece of 2 × 2 cm gauze is used to protect skin from hard plastic of catheter hub and extension tubing connector.
Extension tubing is secured with tape to prevent inadvertent removal of catheter.

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Author

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.

Coauthor(s)

Taylor L Sawyer, DO, MEd, MBA Professor of Pediatrics, University of Washington School of Medicine

Taylor L Sawyer, DO, MEd, MBA 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.

Specialty Editor Board

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.

Chief Editor

Vincent Lopez Rowe, MD, FACS Professor and Chief, Division of Vascular and Endovascular Surgery, Gonda (Goldschmied) Vascular Center, University of California, Los Angeles, David Geffen School of Medicine

Vincent Lopez Rowe, MD, FACS is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association of Program Directors in Vascular Surgery, Los Angeles Surgical Society, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Society of Black Academic Surgeons, Society of Black Vascular Surgeons, Southern California Vascular Surgical Society, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

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.