Pediatric emergency intravenous access. Evaluation of a protocol
R. K. Kanter, J. J. Zimmerman, R. H. Strauss and K. A. Stoeckel
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.
