Consultation with the Specialist
Vascular Access
James Seidel MD, PhD
Achieving vascular access in infants and children is often a challenge for emergency medical technicians, nurses, and physicians. It is a vital intervention in the critically ill or injured child and is necessary for infusing medications and fluids and obtaining blood samples for laboratory analysis. It often takes more than 10 minutes to achieve venous access during pediatric resuscitation. The presence of subcutaneous fat, the small size of peripheral vessels, vasoconstriction, and the behavior of anxious and frightened infants and children often are barriers to successful intravenous line placement. Other factors that may affect success include: 1) the skill of the person performing the procedure, 2) immobilization of the patient and/or extremity, 3) the availability of small over-the-needle catheters, 4) the availability of all materials necessary to secure the line, and 5) the site of catheter placement.
Critically ill or injured pediatric patients need rapid vascular access. Health-care providers, therefore, must understand the priorities for obtaining access to a vein. Peripheral venous access is a satisfactory route for infusions, but no more than 1 to 2 minutes should be spent attempting to establish peripheral intravenous access in ill or injured patients. A reasonable approach to vascular access in these patients is as follows: 1) Attempt peripheral access for 1 to 2 minutes
