Vascular Access

Guidelines:

Pediatrics

Attempt one to two age appropriate catheters.

If unsuccessful, use the EZ-IO for emergent access when patient needs volume or medications rapidly.

1. EZ-IO

May be considered prior to peripheral IV attempts in the following situations:

  • Cardiac arrest
  • Profound hypovolemia
  • IV access not readily available

Contraindications

  • Fracture of tibia or femur; consider alternate side
  • Infection at insertion site
  • Inability to locate landmarks

In awake patients, prior to use,

  • <5 kg slowly administer 0.25 ml (5 mg) of 2% lidocaine over 60 sec, followed by 5 ml of normal saline rapid flush and then 0.25 ml (5 mg) of 2% lidocaine.
  • >6 kg slowly administer 0.5 mL (10 mg) of 2% lidocaine over 60 sec, followed by 5 mL of normal saline rapid flush and then 0.5 ml (10 mg) of 2 % lidocaine.

Citations/References:

  1. The Science and Fundamentals of Intraosseus Vascular Access, Including frequently asked questions. Shavano Park, TX: Vidacare Corporation; July 2012.
  2. HIXSON INTRAOSSEOUS LIDOCAINE GUIDELINE, copyright 2012 Richard Hixson, MD.

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