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Emergency venous access during resuscitation of infants (other than newborns) and children

Emergency venous access during resuscitation of infants (other than newborns) and children
This algorithm provides the approach to venous access in infants (other than newborns) and children who require immediate access within one minute because of cardiac arrest, hypotensive shock, or other critical illness. For more information on how to perform venous access in infants in children, refer to UpToDate topics on venous access for pediatric resuscitation.

CPR: cardiopulmonary resuscitation; IO: intraosseous; IV: intravenous.

* If peripheral veins can be reliably seen or palpated, insert two of the largest IV catheters. For more, refer to UpToDate topics on vascular (venous) access for pediatric resuscitation and other pediatric emergencies.

¶ Obtain IO access using a battery-powered device. The proximal tibia site is preferred. For more, refer to UpToDate topics on IO cannula placement.

Δ During CPR, if no peripheral IV or IO access is achieved after one minute and an endotracheal tube is in place, administer epinephrine endotracheally, as indicated, while continuing to establish venous access. Whenever possible, central lines should be placed under ultrasound guidance. In infants and children undergoing CPR, the femoral vein site is the preferred.

◊ Typical site is the saphenous vein.
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