Pediatric emergency intravenous access. Evaluation of a protocol

Area of Science:

• Pediatric Emergency Medicine
• Critical Care
• Vascular Access Techniques

Background:

• Establishing intravenous (IV) access is critical for administering medications and fluids during pediatric resuscitation.
• Delays in IV access can negatively impact patient outcomes in critical situations.
• Current methods for achieving IV access in pediatric emergencies can be time-consuming and challenging.

Purpose of the Study:

• To prospectively evaluate the effectiveness of a specific protocol for achieving intravenous (IV) access during pediatric resuscitation.
• To determine if adherence to a defined sequence of IV access measures reduces overall access time compared to non-protocolized approaches.
• To assess the impact of sequential IV access techniques on resuscitation efficiency.

Main Methods:

• Prospective evaluation of a standardized protocol for pediatric resuscitation IV access.
• The protocol involved sequential attempts: percutaneous peripheral IV, followed by femoral vein catheterization, saphenous vein cutdown, and intraosseous infusion if needed.
• Comparison of IV access times between resuscitations adhering to the protocol and those deviating from it.

Main Results:

• Utilization of the full protocol significantly reduced IV access time compared to deviations (median 4.5 minutes vs. 10.0 minutes).
• No single technique was universally rapid, but the sequential approach improved overall efficiency.
• Even with partial compliance, 66% of resuscitations achieved IV access within five minutes.

Conclusions:

• A systematic protocol for sequential IV access techniques is effective in reducing time during pediatric resuscitation.
• Pediatric IV access should rarely be delayed beyond five minutes when employing all available techniques.
• The findings support the implementation of standardized IV access protocols in pediatric emergency settings.