Emergency vascular access during resuscitation of newborns (<10 days of age)

* If peripheral veins can be reliably seen or palpated, insert two of the largest intravenous (IV) catheters that can be reliably placed (typically, 24 gauge IV in newborns younger than 10 days of age). 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.
¶ The proximal tibia site is preferred unless otherwise contraindicated (eg, fractured bone or vascular interruption of the extremity).
Δ For providers experienced with the technique, umbilical vein catheterization may be the preferred initial access. Low umbilical venous placement refers to insertion of the line approximately 3 to 5 cm in a full-term infant or 2 to 4 cm in a preterm infant until blood return is achieved. Refer to UpToDate topics on vascular access for pediatric resuscitation.
◊ Femoral site is preferred. If difficulty with central line placement is encountered, obtain emergency consultation with a surgeon with pediatric expertise to obtain vascular access.