The vein that is used in case of an infant depends on the infants age and whether the situation is an emergency or routine.
For emergency and neonatal access, the umbilical vein is used in newborns or infants during the first few day of life up to 7 days to 14 days for emergency resuscitation, fluid delivery and central access via the umbilical vein catheterization stump.
For routine peripheral access the veins that are used on infants include the dorsal hand veins, great saphenous vein, scalp veins and antecubital veins.
Antecubital veins are located inside the elbow bend and are used more often as infants grow older.
Scalp veins are sometimes used in neonates when other peripheral sites are difficult to access.
The great saphenous vein is located on the inside of the infants leg or ankle and is frequently used in younger infants and neonates.
And the dorsal hand veins are located on the back of the infants hand, which is commonly used for older infants and routine blood draws or IV placement.
When starting an IV on a newborn doctors choose the site based on how long the newborn needs treatment and how sick they are.
However IVs are started on newborns in the peripheral veins in the hands, feet and scalp as well as central lines via the umbilical cord.
The common peripheral sites where you start IV on newborns include:
The hands, which include the dorsal venous network on the back of the newborns hand.
The feet, which includes the saphenous veins or the dorsal arch on top of the newborns foot.
The scalp, which includes the superficial temporal, frontal, or auricular veins, which are also often prominent and visible in neonates.
And the arms, which include the Antecybital fossa or the inner elbow veins, although flexion areas are also prone to dislodging.
The special and central sites for starting an IV on newborns include:
An umbilical venous catheter or (UVC), which uses the vein in the umbilical cord stump for rapid or ey delivery room access and long term fluids.
PICC lines, which are peripherally inserted central catheters that are threaded through the arm, leg or scalp veins for long term nutrition.
And intraosseous (IO), which involves emergency bone marrow access in the tibia or femur if the veins of the newborn fail.
For peripheral intravenous (IV) access in infants, the dorsum of the hand and the great saphenous vein at the ankle/foot are considered the safest and most standard primary sites.
Distal veins are preferred first to preserve vein health, and selection depends heavily on the infant's mobility level.
Safety and Placement Considerations for IVs in newborns include:
Catheter size: A small, short 24-gauge or 26-gauge catheter is standard to minimize vessel trauma.
Joint avoidance: Avoid areas of flexion (like the wrist or antecubital fossa) whenever possible to prevent the line from kinking or dislodging.
Immobilization: Careful splinting of the limb is vital because infant movement easily dislodges peripheral lines.
Monitoring: Frequent hourly checks are required to catch fluid leakage into surrounding tissue (infiltration) early.