PE15.3-4 | Emergency Vascular Access — Summary & Reflection

KEY TAKEAWAYS

Peripheral IV cannulation (PE15.3) is first-line vascular access in children; preferred sites are dorsal hand veins, antecubital fossa, and saphenous vein at the ankle (scalp veins in neonates). Technique: 15-20° insertion, bevel up, skin traction, act on flashback, advance cannula off needle, confirm with aspiration and flush, watch for infiltration. Intraosseous (IO) access (PE15.4) is indicated after 2 failed IV attempts or 90 seconds in a critically ill child. Standard site: anteromedial proximal tibia, 2-3 cm below the tibial tuberosity, 90° insertion angle. Three-step confirmation: needle stands upright + aspiration (may be absent in shock) + saline flush free-flowing with no swelling. IO delivers all resuscitation drugs and fluids as effectively as IV. Contraindications to IO include fracture, prior IO at same site within 24 hours, osteogenesis imperfecta, and overlying infection. All IO-delivered drugs require a 5-10 mL saline flush immediately after.

REFLECT

Return to the opening scenario — the 18-month-old in cardiac arrest, two failed IV attempts in 90 seconds. Now that you have studied the steps: walk through exactly what you would do from the moment the registrar says 'Get IO access now' — from positioning the limb to confirming placement. Then reflect: what would make you NOT use the proximal tibia as the IO site in this child? And if you had established IO access and given adrenaline, what is the next immediate step after drug delivery? Writing this sequence out consolidates the procedural knowledge into a retrievable mental script for the emergency setting.