7 Vascular Access

Question 1

complications in IO insertion

Answer 1

rate of serious complications from IO insertion is ≤1%

by comparison, central venous catheters have complication rates of at least 3.4%

Question 2

the principal limitation of IO access is

Answer 2

a relatively low maximum flow rate

Question 3

most commonly accessed intraosseous site

Answer 3

anteromedial proximal tibia
the flat surface of the anteromedial proximal tibia is easily accessible given the paucity of overlying tissue

insert the needle 2 cm inferior (distal) to the tibial tuberostiy to avoid the physeal plate in children

Question 4

remarks on IO insertion

Answer 4

no more than one attempt per bone is recommended

in general, radiographs are not needed after IO removal unless there’s suspicion of a complication

remove IO needles as soon as another stable route of vascular access is established

Question 5

remarks on subclavian vein catheterization

Answer 5

place the child’s head in a neutral position, without the use of a shoulder roll, as this maximizes vein diameter

Question 6

remarks on internal jugular vein catheterization

Answer 6

in children, the combination of the Valsalva maneuver, liver compression, and Trendelenburg positioning maximizes the distention of the internal jugular vein

Question 7

remarks on femoral vein catheterization

Answer 7

in children, as compared to adults, the fermoral site may not be associated with higher infection rates and is easier to place in a responsive child, and mechanical complications are less likely to be severe

Question 8

remarks on umbilical vein catheterization (UVC)

Answer 8

in general, UVC is limited to the _first week_ of life

the umbilical vein is continuous with the portal vein

an alternative to umbilical access for neonatal resuscitation is IO placement, which may be preferable for those not trained in umbilical access

Question 9

inserting umbilical vein catheter

Answer 9

in emergency situations, advance the catheter only 1 to 2 cm beyond the point of good blood return; this is typically 4 to 5 cm from the end of the umbilical stump in a term infants

If there is free return of blood, the line can be used.

In this technique, the catheter extends only a few centimeters into the abdomen, so radiogarphic confirmation is not necessary