Abstract

The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completly replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access.

Highlights

  • Nothing can be more difficult, time consuming and frustrating than obtaining vascular access in the paediatric patient

  • Use of the external jugular vein (EJV) for central venous access with a guide-wire technique is associated with a 75–100% success rate in adult patients and a very low complication rate [78]

  • Application of local warmth proved to be beneficial in increasing the success rate of peripheral venipuncture in children, even in small patients

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Summary

Introduction

Nothing can be more difficult, time consuming and frustrating than obtaining vascular access in the paediatric patient. This was best described by Orlowski in 1984 [1], who stated, ‘My kingdom for an intravenous line’. This article reviews the various sites and techniques that may be used to gain acute intravascular access in the routine situation and in emergency or intensive care settings

Methods
Conclusion
Orlowski JP
Nyamuginduru G
50. Smith MF
90. Kruger C
Findings
94. Lindsey J
Full Text
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