Clinical review: vascular access for fluid infusion in children

Area of Science:

• Pediatric Emergency Medicine
• Vascular Access Techniques
• Critical Care Pediatrics

Background:

• Establishing acute intravascular access is crucial for infants and children in routine, emergency, and intensive care settings.
• Various methods exist to facilitate venous cannulation, including local warmth, transillumination, and topical nitroglycerin.

Purpose of the Study:

• To review current literature on venous access in pediatric patients.
• To describe techniques for facilitating venous cannulation.
• To identify preferred sites and evaluate the safety and efficacy of different venous access methods in children.

Main Methods:

• Comprehensive literature review of studies on pediatric venous access.
• Analysis of techniques for venous cannulation, including site selection and adjunctive methods.
• Evaluation of complication rates and success of different procedures.

Main Results:

• Femoral venous cannulation is identified as a highly safe and reliable technique across all pediatric age groups, demonstrating high success and low complication rates.
• Real-time ultrasound guidance is strongly supported by evidence for improving venous cannulation success in infants and children.
• Intraosseous access has largely replaced saphenous cutdown for emergency vascular access in children, reducing the need for immediate central venous access.

Conclusions:

• Femoral venous cannulation and ultrasound-guided techniques are recommended for optimal venous access in pediatric patients.
• Intraosseous access is a critical alternative in pediatric emergencies.
• Evidence supports specific techniques for safe and effective pediatric vascular access.