Scalp veins

While clearing up after teaching with my bald colleague Dr Phil Hyde yesterday I noticed his bulging scalp veins and this reminded me that we don’t talk about this route much in our Paediatric Emergency Medicine Course.

This prompted me to look up the complications of scalp vein access in neonates and infants, which include:

  • scalp abscess
  • alopecia
  • intracranial abscess
  • thrombophlebitis
  • intracranial venous sinus air embolism
  • scalp necrotising fasciitis

Phil's bulging scalp veins

Suggested ways to decrease the risk of complications include:

  • A vein should not be used for more than 24 h at a time
  • The needle entry point should not be covered
  • The butterfly needle should be immobilized to avoid movements of the needle into the tissue with consequent extravasation of fluid
  • The infusion site should be monitored by regular examination
  • If a swelling or leakage of fluid is noted, the infusion should be discontinued immediately from that site
  • The hair should be properly shaved
  • If the line is required for more than 24 h, a peripheral venous cutdown or central venous line should be considered, after initial resuscitation
  • An alternative route for rehydration (e.g. intraosseous infusion) should be considered initially, rather than risk multiple, unsuccessful attempts at scalp vein cannulation.

Complications of scalp vein infusion in infants
Trop Doct. 2005 Jan;35(1):46-7

Air emboli in the intracranial venous sinuses of neonates
Am J Perinatol. 2002 Jan;19(1):55-8