PALS Provider: Course
Peripheral Intravenous (IV) Access in Children
Peripheral intravenous (IV) access is critical in pediatric resuscitation, allowing for rapid administration of fluids, medications, and blood products. However, securing IV access in children is often challenging due to small veins, movement, and distress.
Why Is IV Access Important?
- Provides immediate circulatory access for emergency medication and fluids.
- Essential for resuscitation, fluid resuscitation, and medication administration.
- In pediatric emergencies, IV access must be established quickly—but alternative routes should be considered if unsuccessful.
Key Considerations for Pediatric IV Access
Site Selection
| Age Group | Preferred IV Access Sites |
|---|---|
| Neonates (<28 days) | Dorsum of the hand, foot veins, scalp veins (if other sites unavailable) |
| Infants (1–12 months) | Hand, foot, antecubital fossa, saphenous vein |
| Children (>1 year) | Antecubital fossa, dorsum of the hand, wrist, foot veins |
Note: Avoid lower limb IV sites in critically ill children, as they may compromise circulation if intra-abdominal pressure increases.
Choosing the Right IV Catheter Size
| Patient Age | Recommended IV Catheter Size |
|---|---|
| Neonates & Premature Infants | 24G (blue) |
| Infants (<1 year) | 22–24G (blue/yellow) |
| Young Children (1–6 years) | 20–22G (pink/blue) |
| Older Children (≥6 years) | 18–20G (green/pink) |
- Smaller catheters (22–24G) are used for neonates and infants due to fragile veins.
- Larger catheters (18–20G) allow faster fluid resuscitation in older children.
Steps for Peripheral IV Insertion in Children
- Prepare Equipment: IV catheter, antiseptic wipes, flush, extension set, pain control if time permits.
- Position the Child: Swaddle infants, involve parents, use distraction or child life specialists.
- Select and Clean the Site: Use transillumination if needed, apply tourniquet, clean with antiseptic.
- Insert the IV: Use a 10–30° angle, advance slowly, confirm flashback, advance catheter, withdraw needle.
- Flush and Secure: Confirm patency, secure with dressing, label and document.
Special Considerations: Avoid excessive force in neonates. If multiple IV attempts fail, proceed to intraosseous access.
Challenges & Troubleshooting IV Access in Children
| Challenge | Cause | Solution |
|---|---|---|
| Difficult vein visualization | Small or deep veins | Use transillumination, vein finder, ultrasound-guided IV |
| Vein collapse | Dehydration or suction | Use larger vein, warm compress, gentle suction |
| Infiltration | Poor placement/dislodgement | Reposition or replace IV, monitor swelling |
| Pain and distress | Fear, inadequate sedation | Use topical anesthetics, distractions |
Signs of Infiltration/Extravasation: Swelling, cool skin, pain, poor flow. Stop infusion, elevate limb, and administer antidote if needed.
Alternative Access Options if IV Fails
| Alternative Access | Best For | Key Considerations |
|---|---|---|
| Intraosseous (IO) | Emergency meds/fluids | First-line backup in critically ill children |
| Umbilical Venous Catheter (UVC) | Neonates | Used in neonatal resuscitation |
| Central Venous Catheter (CVC) | Long-term access | Used in ICU or prolonged therapy |
Note: If IV access is not secured within 60–90 seconds, move to IO access without delay.
Summary: Why Peripheral IV Access Is Critical in Pediatric Resuscitation
- Peripheral IV access enables life-saving medications and fluids to be administered rapidly.
- Choose the right site and catheter size based on age and condition.
- If IV fails after 2–3 attempts, escalate to IO or another route.
- Secure the IV well to prevent dislodgement, especially in active children.
Takeaway: Quick and efficient IV access is crucial in pediatric emergencies. Mastering the technique ensures timely and effective interventions.