Equipment
Having the appropriate equipment is of utmost importance for successful scalp vein catheterization. Minimum equipment required includes the following:
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Elastic band tourniquet
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Adequate lighting
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Antiseptic wipes
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Syringes, filled with 0.9% saline, for flush
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Tape for securing the intravenous (IV) catheter and tubing
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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
Patient Preparation
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.
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Common sites of insertion for peripheral scalp vein catheterization include frontal, posterior auricular, and superficial temporal veins.
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Elastic band is used as tourniquet to distend scalp veins. Small piece of tape attached to elastic facilitates removal.
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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.
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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.
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When both needle tip and catheter tip are inside vessel lumen, catheter is advanced forward (1) off needle and further into vein.
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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.
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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.
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Extension tubing is secured with tape to prevent inadvertent removal of catheter.
