Procedure
IV Access
search
IV Access
, Intravenous Access, Venous Cannula Insertion, Vascular Access
See Also
Peripheral IV Access
Central IV Access
Intraosseous Access
Ultrasound-Guided Internal Jugular Vein Catheterization
Ultrasound-Guided Antecubital Line
Umbilical Artery Catheter
Umbilical Vein Catheter
Bloodstream Infections in Hemodialysis
Hypodermoclysis
Central Line-Associated Bloodstream Infection
s (
CRBI
)
Difficult Intravenous Access in Children
Approach
Peripheral Access
Peripheral IV Access
(default initial line)
Gauge 18 or larger is preferred
Initial
Resuscitation
with fluids
Fluid infusion via 18 gauge peripheral IV is faster than via a triple lumen central catheter
Medication administration including antibiotics
Intravenous Contrast
administration (reliable 18 gauge IV needed for CTA, PE studies)
Initial
Vasopressor
s may be used peripherally if reliable large bore IV (until central access is obtained)
Allows for venous lab samples on placement and later
Requires wasting part of sample, and then
Flushing
line
Intraosseous Access
Rapid landmark based placement with multiple available sites (e.g. proximal tibia,
Humerus
)
Emergent Vascular Access for
Resuscitation
when peripheral IV cannot be immediately placed
Allows for infusion of most fluids and medications including
Vasopressor
s (but not
Sodium Bicarbonate
)
Midline Venous Catheter
(
Ultrasound-Guided Antecubital Line
)
Alternative to central venous access when standard peripheral lines are difficult
Extravasation is more common with deep brachial vein IVs
Rapid Infusion Catheter
(RIC Line)
Converts a 18-20 gauge peripheral IV into a large bore line (8 Fr)
Seldinger wire is threaded through peripheral line and peripheral IV is removed
Skin is nicked at IV entry site and dilator is threaded over wire and through skin
Catheter is threaded over wire and into vein and wire is removed
Allows for high flow rates via peripheral line
Risk of destroying peripheral vein by threading it with too large of a catheter
Approach
Central Access
See
Central IV Access
Background
Central Line
s are sewn in place and typically more secure than peripheral lines which may be dislodged
Internal
Jugular Vein
s are preferred central access points
However, in
Resuscitation
, consider femoral lines which are out of way of
Resuscitation
efforts
Convert femoral lines to other sites in first 48 hours
Central Line
Types
Triple Lumen Catheters
Best for infusing multiple medications (including
Vasopressor
s)
Slower infusion rates (under pressure) than 18 gauge peripheral IVs
Introducer Catheters
Largest bore of the central catheter options offering high infusion rates
Weingart recommends bypassing side port with commercially available product
Hemodialysis
Catheters
Large bore catheter (12-13 french) with 2 ports
References
Weingart and Swaminathan in Herbert (2021) EM:Rap 21(4): 5-7
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