Emergency vascular access during resuscitation of infants and children

* If peripheral veins can be reliably seen or palpated, insert two of the largest intravenous (IV) catheters that can be reliably placed (typically, 22 to 24 gauge IV in infants and 18 to 20 gauge in children). Potential sites include the upper and lower extremities, the scalp, and the external jugular vein. Refer to UpToDate topics on vascular (venous) access for pediatric resuscitation and other pediatric emergencies.

¶ Intraosseous access using a battery-powered device is recommended. The proximal tibia site is preferred unless otherwise contraindicated (eg, fractured bone or vascular interruption of the extremity).

Δ Whenever possible, central lines should be placed under ultrasound guidance. In infants and children undergoing cardiopulmonary resuscitation, the femoral vein site is the preferred.