[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › Peripheral IV therapy in children: sites, securement, pumps and fluid-overload risk # Peripheral IV therapy in children: sites, securement, pumps and fluid-overload risk - Procedure Children's IV lines fail and leak easily, so choose the site carefully, protect it, check it every hour and watch the volume they receive. Updated Nov 13, 2026 ## Key points - Sites: upper or lower limbs, or the scalp in neonates and young infants; in one large series the back of the hand had fewer leaks than the head, wrist or forearm. - Check the site and patency every hour in children, and record the volume infused. - Signs of infiltration: swelling, pain, pallor, coolness, slowed infusion or difficulty flushing; severe cases show poor pulse and blistering. - If you suspect infiltration: stop the infusion first, then assess, grade and report. - Replace peripheral catheters in children only when clinically indicated, not on a fixed schedule. - Infants aged 1–12 months had the highest rate of infiltration in a large paediatric series. ## What it is A peripheral IV line in a child carries the same risks as in an adult, plus some of its own. Children's veins are small and fragile, the skin is thin and the tissue stretches, so fluid that leaks out of the vein (infiltration, or extravasation if the fluid is irritant) can spread a long way before anyone notices, and young children cannot report it. Nursing care centres on site choice, secure protection of the line, hourly checks, accurate infusion control and a precise record of what goes in. ## Indications - Intravenous fluids or medicines prescribed when the oral route is not possible or not enough. - Hydration, maintenance fluids, antibiotics and other intravenous treatment as ordered. - Venous access for an emergency, per the medical plan. ## Contraindications and precautions - In a large paediatric series, sites over the wrist and forearm leaked more often than the back of the hand. - Avoid steel needles for fluids or medicines that can damage tissue if they leak. - Infants and young children cannot report pain: rely on looking and feeling the site. - Children who move a lot need the line and tubing protected from pulling. - Irritant or vesicant drugs need extra vigilance and the institution's extravasation protocol. ## Equipment - Catheter of suitable size, antiseptic, transparent semi-permeable dressing. - Securement device or tape, gauze wrap or arm board to protect the line. - Infusion pump or controlled-volume set per protocol, with paediatric settings. - Intake and output chart, PIV assessment or infiltration scale used by the service. ## Step by step (and why) - Check the order, the child's weight and the solution, rate and limits — infusion errors weigh more in a small body. - Prepare the child and family and use comfort measures and a comfort hold — fear and movement make access harder. - Choose the site by age and need; the back of the hand had fewer leaks in a large series — a lasting line spares the child more attempts. - Follow the institution's rule on the number of attempts and when to call a more experienced colleague — each attempt hurts the child. - Cover with a transparent dressing and secure the catheter and tubing — you must be able to see the site. - Protect the line with a gauze wrap or arm board and keep fingers or toes visible — children may pull at it; you need to check circulation. - Run the infusion through a pump or controlled-volume set as the protocol requires — the volume must match the order exactly. - Every hour, look at and gently feel the site, compare limbs, and check patency and volume infused — leaks spread quickly and silently. - Record volumes, site findings and the child's response in the chart — trends reveal overload or infiltration early. ## Complications - Infiltration or extravasation: swelling, pain, coolness, pallor; severe grades with poor pulse, blistering or skin damage. - Phlebitis and catheter infection: redness, warmth, tenderness along the vein. - Occlusion and dislodgement. - Fluid overload: raised breathing rate and blood pressure, falling oxygen saturation, oedema, crackles. - Pain and fear linked to repeated attempts. ## Next step: when to call for help - Suspected infiltration: stop the infusion, grade it, elevate the limb and call the nurse in charge or doctor; follow the extravasation protocol for irritant drugs. - Pale, cold limb, poor pulse below the site, blisters or skin damage: urgent report. - Signs of fluid overload (fast breathing, raised blood pressure, falling saturation, oedema, crackles): report at once. - Redness, warmth or fever with a line in place: report; the catheter may need removal. - Record the event, the actions taken and what was explained to the child and family. ## Test yourself Think of the answer, then tap the question to see it. ## How often is a child's peripheral IV site checked? Every hour, looking and feeling for swelling, coolness, pallor and pain, and checking patency and volume. ## Which sites can be used for a peripheral IV in an infant? Veins of the upper or lower limbs, or the scalp in neonates and young infants. ## What is the first action when infiltration is suspected? Stop the infusion, then assess and grade the site, elevate the limb and report. ## When is a child's peripheral catheter replaced? Only when clinically indicated, not on a fixed schedule. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/peripheral-iv-therapy-in-children-sites-securement-pumps-and-fluid-overload-risk/) ## Connections ## Related 3 - [Inserting a peripheral IV catheter](https://durgical.com/en/nursing/inserting-a-peripheral-iv-catheter/) - [IV complications: phlebitis, infiltration and extravasation](https://durgical.com/en/nursing/iv-complications-phlebitis-infiltration-and-extravasation/) - [Maintenance fluid volume in children (Holliday–Segar), worked examples](https://durgical.com/en/nursing/maintenance-fluid-volume-in-children-worked-examples/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011, updated 2017)](https://www.cdc.gov/infection-control/media/pdfs/Guideline-BSI-H.pdf) (Centers for Disease Control and Prevention, 2017); [Nursing Skills, 23.3 Intravenous Therapy Assessment (Open RN, CC BY 4.0)](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/23%3A_IV_Therapy_Management/23.03%3A_Intravenous_Therapy_Assessment) (Open Resources for Nursing (Open RN) / LibreTexts, 2021); [Peripheral intravenous therapy infiltration and extravasation (PIVIE) risks in 11 006 paediatric surgery inpatients in China: a retrospective observational study (J Int Med Res 52(10))](https://pmc.ncbi.nlm.nih.gov/articles/PMC11497536/) (Journal of International Medical Research (open access, PMC11497536), 2024); [Elaboration and validation of an algorithm for treating peripheral intravenous infiltration and extravasation in children (Rev Lat Am Enfermagem 29:e3435)](https://pmc.ncbi.nlm.nih.gov/articles/PMC8253344/) (Revista Latino-Americana de Enfermagem (open access, PMC8253344), 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/peripheral-iv-therapy-in-children-sites-securement-pumps-and-fluid-overload-risk/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/peripheral-iv-therapy-in-children-sites-securement-pumps-and-fluid-overload-risk/