IV

It's so easy to take the simple intravenous catheter for granted. All through my intern year, I can't really remember an instance where I couldn't give someone an IV medication. And all through the last year of anesthesia, I could manage an IV in most patients. But children are different. I can no longer take an IV for granted. Sometimes, older children and teenagers will allow us to place a lidocaine patch to numb the skin and then make one attempt. But most of our small children require some oral midazolam syrup prior to going to the operating room where they get a mask induction. After going to sleep by gas, we sometimes struggle to place an IV. Surprisingly, veins in babies are deeper than expected; they wriggle through a layer of subcutaneous fat. Unlike adults whose veins pop out with a tourniquet, toddler's veins are often just a shadow under the skin, barely discernible. I've never been so frustrated as trying to get an IV in pediatrics. It also means that we occasionally do simple cases without IV access, relying instead on intramuscular injections for emergency medications and rectal acetaminophen for analgesia.