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Pediatric Emergency Intravenous Access: Evaluation of a Protocol

Pediatric Emergency Intravenous Access: Evaluation of a Protocol Abstract • Effectiveness of a protocol for intravenous (IV) access during pediatric resuscitation was prospectively evaluated to determine whether utilization of a specified sequence of measures would reduce IV access time compared with resuscitations deviating from the protocol. The protocol involved rapid sequential attempts at percutaneous femoral vein catheterization, saphenous vein cutdown, and intraosseous infusions if initial percutaneous peripheral IV insertion failed. While no single technique provided completely reliable and rapid IV access, utilization of all techniques per protocol significantly improved IV access time. When initial percutaneous peripheral IV attempts failed, resuscitations in compliance with the protocol achieved IV access more rapidly (median, 4.5 minutes) than those deviating from the protocol (median, 10.0 minutes). Even with incomplete compliance, 66% of resuscitations achieved IV access within the first five minutes. Our experience indicates that IV access during pediatric resuscitation should rarely be delayed beyond the fifth minute if all available IV techniques are used. (AJDC 1986;140:132-134) References 1. Orlowski JP: My kingdom for an intravenous line . AJDC 1984;138:803. 2. Rossetti V, Thompson BM, Aprahamian C, et al: Difficulty and delay in intravenous access in pediatric arrests . Ann Emerg Med 1984;13:406.Crossref 3. Randolph J: Technique for insertion of plastic catheter into saphenous vein . Pediatrics 1959;24:631-637. 4. Swanson RS: Emergency intravenous access through the femoral vein . Ann Emerg Med 1984;13:244-247.Crossref 5. Berg RA: Emergency infusion of catecholamines into bone marrow . AJDC 1984;138: 810-811. 6. Chameides L, Melker R, Raye JR, et al: Resuscitation of infants and children , in McIntyre KM, Lewis AJ (eds): Textbook of Advanced Cardiac Life Support . Dallas, American Heart Association, 1983, pp 255-272. 7. Colton T: Statistics in Medicine . Boston, Little Brown & Co Inc, 1974, pp 221-223. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Pediatric Emergency Intravenous Access: Evaluation of a Protocol

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1986.02140160050030
Publisher site
See Article on Publisher Site

Abstract

Abstract • Effectiveness of a protocol for intravenous (IV) access during pediatric resuscitation was prospectively evaluated to determine whether utilization of a specified sequence of measures would reduce IV access time compared with resuscitations deviating from the protocol. The protocol involved rapid sequential attempts at percutaneous femoral vein catheterization, saphenous vein cutdown, and intraosseous infusions if initial percutaneous peripheral IV insertion failed. While no single technique provided completely reliable and rapid IV access, utilization of all techniques per protocol significantly improved IV access time. When initial percutaneous peripheral IV attempts failed, resuscitations in compliance with the protocol achieved IV access more rapidly (median, 4.5 minutes) than those deviating from the protocol (median, 10.0 minutes). Even with incomplete compliance, 66% of resuscitations achieved IV access within the first five minutes. Our experience indicates that IV access during pediatric resuscitation should rarely be delayed beyond the fifth minute if all available IV techniques are used. (AJDC 1986;140:132-134) References 1. Orlowski JP: My kingdom for an intravenous line . AJDC 1984;138:803. 2. Rossetti V, Thompson BM, Aprahamian C, et al: Difficulty and delay in intravenous access in pediatric arrests . Ann Emerg Med 1984;13:406.Crossref 3. Randolph J: Technique for insertion of plastic catheter into saphenous vein . Pediatrics 1959;24:631-637. 4. Swanson RS: Emergency intravenous access through the femoral vein . Ann Emerg Med 1984;13:244-247.Crossref 5. Berg RA: Emergency infusion of catecholamines into bone marrow . AJDC 1984;138: 810-811. 6. Chameides L, Melker R, Raye JR, et al: Resuscitation of infants and children , in McIntyre KM, Lewis AJ (eds): Textbook of Advanced Cardiac Life Support . Dallas, American Heart Association, 1983, pp 255-272. 7. Colton T: Statistics in Medicine . Boston, Little Brown & Co Inc, 1974, pp 221-223.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Feb 1, 1986

References