Do not waste time trying to get anintravenous (IV) line on an infant in shock when an intraosseous (IO) line will do just as well
Do not waste time trying to get anintravenous (IV) line on an infant in shock when an intraosseous (IO) line will do just as well: Excerpt from Avoiding Common Pediatric Errors
Author:
William Giasi, Jr., MD
What to Do - Take Action
There are thousands of emergencies every year that require the resuscitation
of infants and children. These emergencies can occur in almost any setting
and providers need to be prepared to intervene. The goal in any resuscitation
is to maintain adequate oxygenation and perfusion while interventions are
takentostabilizethechild.Resuscitationshouldproceedinanorderlyfashion
beginning with the ABCs: airway, breathing, and circulation.
As part of the circulation sequence during advanced life support, it is
necessary for the provider to establish venous access as a route to administer
medications, fluids, and blood products, and to obtain blood for analysis.
Nevertheless,eveninthehandsofexperiencedproviders,obtainingIVaccess
in pediatric patients can be difficult. The preferred site for access is the one
that is readily accessible and will not interfere with the resuscitation. There
are several peripheral sites that providers should familiarize themselves with
where IV access can be obtained. Central venous access is another option in
the event that the proper equipment and trained personnel are available. An
attempt to establish peripheral and central venous access can be approached
simultaneously.
Ifperipheralorcentralvenousaccessisunattainablein<1minuteduring
resuscitation, current recommendations urge the use of IO cannulation. The
administration of potentially lifesaving drugs and interventions should not
be delayed while attempting venous access. IO access provides access to a
noncollapsable venous network, which can serve as a rapid, safe, and reliable
route via which drugs, fluids, and blood products may be administered.
Following the establishment of IO access, providers can continue to explore
other peripheral and/or central routes of access to support the patient's
ongoing care.
In the infant and child, the anteromedial surface of tibia is the preferred
site for insertion of the IO needle because it is a large bone with a thin layer
of subcutaneous tissue. The location and anatomy of this region allows for
landmarks to be readily palpated, access obtained, and does not interfere
with airway management or cardiopulmonary resuscitation.
Suggested Readings
Mathers LH and Frankel LR. Chapter 57.1 Pediatric Emergencies and Resuscitations. In:
Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed.
Philadelphia: Saunders; 2004, pages 291–95.
Stanley R. Intraosseous infusion. In: Roberts JR, Hedges JR, eds. Roberts: Clinical Procedures
in Emergency Medicine, 4th ed. Philadelphia: Saunders; 2004, pages 475–85.
Zaritsky A. Vascular access. In: American Heart Association. PALS Provider Manual. Dallas,
TX: American Heart Association; 2002:155–172.
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Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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