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.