An emergency intravenous route for the pediatric patient

In pediatric patients, percutaneous venipuncture is preferable to cutdown, especially in inexperienced hands. The best route for maintenance fluid administration is a No. 19, No. 21 or No. 23 scalp vein needle or No. 18 or No. 20 plastic cannula placed in a superficial hand or foot vein. An incision 1 cm proximal to the medial malleolus of the tibia over the great saphenous vein is the classic pediatric cutdown. Other alternatives are brachial vein, saphenous vein distal to the medial aspect of the knee and, in extreme emergencies, the external jugular vein or cephalic vein in the arm. The cutdown technique with facilitating suggestions and possible dangers is described.