Chapter 8

• • Vascular access in nonemergent situations or temporary access in emergent situations.

• Administration of fluids and electrolytes.

• Administration of blood and blood products.

• Blood sampling.

### Absolute

• • Do not insert through an infected site.

• Do not insert through a burn.

• Do not insert in an injured site.

### Relative

• • Avoid a paralyzed extremity.

• Do not insert in a massively edematous extremity.

• Do not insert an IV distal to injured organs (eg, do not use lower extremities when treating abdominal injuries).

• Avoid joint area.

 • Caution: All equipment must be latex free.

• • Gloves.

• Tourniquet or rubber band.

• Tape and occlusive transparent dressing.

• Alcohol wipes.

• Povidone or chlorhexidine.

• Syringe filled with injectable saline.

• IV device: catheter or butterfly of appropriate size to fit the patient and the task.

• Topical anesthetic cream.

• • Ultrasound guiding equipment (if available and if trained in its use).

• • Infection.

• Hematoma.

• Extravasation.

• Compartment syndrome.

• Severe vasoconstriction if vasoactive medications are infused through a peripheral IV and extravasate.

• Venous thrombosis.

• Embolization of air or catheter fragment.

• • Plan the procedure.

• Limit the procedure time.

• Have a backup plan.

• Examine all possible sites carefully before choosing one.

• Apply gentle circumferential pressure with 1 hand on the extremity to fill up the veins, which helps identify the most appropriate site.

• In choosing the equipment and the site for the line, consider the patient’s needs.

• • A trauma patient will require a large bore line, preferably a short one in order to avoid high resistance with high flows.

• • Introduce yourself to the parents and to the patient.

• Explain to the parents and the child, if appropriate, the procedure and its purpose.

• Choose 1 or more possible sites, and apply topical anesthetic cream.

• Answer all of the parents’ and patient’s questions.

• • Position the patient with the chosen site closest to you.

• Have a helper gently restrain and distract the child.

• Have the patient at a comfortable working height.

• For external jugular line placement, have the patient’s head lower than the trunk (Trendelenburg).

• • Accessible peripheral veins that are usually available include the following (Figure 8–1):

• • On the dorsum of the hands.

• On the radial side of the hand.

• In the antecubital fossa.

• The saphenous vein at the medial aspect of the ankle.

• The dorsum of the feet.

• External jugular vein.

• In infants, additional sites include scalp veins.

###### Figure 8–1.

Common sites ...

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