23.10 Central and peripheral intravenous lines
Background
Most children who present to an emergency department do not need vascular access for drug or fluid therapy. Medications can usually be administered orally, transmucosally, intramuscularly or by inhalation. Even fluid administration in dehydrated children does not ordinarily require vascular access. Oral rehydration, performed slowly and methodically, is often successful in children with vomiting and/or diarrhoea. However, when oral rehydration is unsuccessful or when a child presents critically ill or injured, intravenous (IV) or intraosseous (IO) access (Chapter 23.11) becomes essential.
Finding veins to cannulate in infants and small children can be quite a challenge. The higher ratio of subcutaneous fat and smaller vessel size in young patients pose significant barriers to rapid venous cannulation. A peripheral venous site, rather than a central site, offers the highest benefit:risk ratio of any vascular access option. Fig. 23.10.1 illustrates common sites for peripheral IV line insertion.
When a peripheral site is unavailable, an IO site provides a second option (Chapter 23.11). When peripheral venous and IO access cannot be obtained or if central venous pressure monitoring is required, consider cannulating central veins, such as the femoral vein, subclavian vein, or internal jugular vein. Avoid saphenous vein cutdowns in children, because they are technically difficult to perform and the technique is time consuming in infants and young children, even for experienced operators. Make every effort to provide the least invasive form of access required by the degree of the child’s illness.
Indications
Contraindications
Peripheral venous line placement
Equipment
Table 23.10.1 lists peripheral IV equipment. Determine appropriate sizing of IV catheters by consulting a length-based resuscitation tape.
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Preparation
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Procedure
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