Peripheral intravenous (IV) access is critical in pediatric resuscitation, allowing for rapid administration of fluids, medications, and blood products. However, securing IV access in children is often challenging due to small veins, movement, and distress.
Why is IV Access Important?
IV access sites vary by age and clinical condition:
Age Group | Preferred IV Access Sites |
---|---|
Neonates (<28 days) | Dorsum of the hand, foot veins, scalp veins (if other sites unavailable) |
Infants (1-12 months) | Hand, foot, antecubital fossa, saphenous vein |
Children (>1 year) | Antecubital fossa, dorsum of the hand, wrist, foot veins |
Avoid lower limb IV sites in critically ill children, as they may compromise circulation if intra-abdominal pressure increases.
Using the correct IV catheter size optimizes flow rates and prevents vein trauma:
Patient Age | Recommended IV Catheter Size |
---|---|
Neonates & Premature Infants | 24G (blue) |
Infants (<1 year) | 22-24G (blue/yellow) |
Young Children (1-6 years) | 20-22G (pink/blue) |
Older Children (≥6 years) | 18-20G (green/pink) |
Smaller catheters (22-24G) are used for neonates and infants due to fragile veins.
Larger catheters (18-20G) allow faster fluid resuscitation in older children.
Prepare Equipment:
Position the Child Comfortably:
Select the Best Vein & Clean the Site:
Insert the IV Catheter:
Flush and Secure the IV:
Special Considerations:
In neonates, avoid excessive force, as veins are fragile.
If multiple IV attempts fail (after 2-3 attempts), switch to an alternative route (e.g., intraosseous access).
Challenge | Cause | Solution |
---|---|---|
Difficult vein visualization | Small or deep veins | Use transillumination, vein finder, or ultrasound-guided IV placement |
Vein collapse | Excessive negative pressure or dehydration | Try a larger vein, use warm compress, avoid excessive suction |
Infiltration (IV fluid leaking into tissue) | Poor catheter placement or dislodgement | Reposition or replace IV, monitor for swelling |
Pain and distress | Fear, lack of sedation | Use topical anesthetics, distraction techniques |
Signs of IV Infiltration or Extravasation:
If extravasation occurs: Stop the infusion, elevate the limb, and consider antidote administration for vesicant medications.
If peripheral IV access is not achievable within 60-90 seconds, consider alternative routes:
Alternative Access | Best for | Key Considerations |
---|---|---|
Intraosseous (IO) Access | Emergency fluid/medication administration | First-line alternative to IV in critically ill children |
Umbilical Venous Catheter (UVC) | Neonates | Useful in neonatal resuscitation |
Central Venous Catheter (CVC) | Long-term access | Used in critically ill patients for prolonged medication/fluid administration |
Intraosseous (IO) access is the fastest alternative in emergencies! If a child is in shock or cardiac arrest and IV access cannot be secured, place an IO line immediately.
Peripheral IV access is the first step in providing life-saving medications and fluids.
Site selection and catheter size should be tailored to the child’s age and condition.
If multiple IV attempts fail, escalate to intraosseous (IO) or other alternative routes.
Always secure the IV well to prevent dislodgement in active pediatric patients.
Takeaway: Quick and efficient IV access is crucial in pediatric emergencies. Mastering the technique ensures timely and effective interventions.