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PEM Pearls: Pediatric Ultrasound-Guided Peripheral IV Access

2018-02-05T21:18:43+00:00

Pediatric Ultrasound-Guided Peripheral IV AccessPediatric patients are not just little adults. Placing peripheral IVs in young patients can be challenging and comes with its own set of challenges. Presented are some basic and advanced tips to maximize success in establishing peripheral IV access in pediatric patients using ultrasonography.

Ultrasound-Guided Peripheral IV Tips

The Bottom Line

  • Supplies: Collect all of your supplies before starting the procedure, specifically:
    • An underpad (e.g., a chux) to catch any stray blood
    • Sterile ultrasound gel
    • Extra gauze to clean up the gel
  • IV catheter: Choose a catheter long enough to reach the deep veins and large-bore enough for fluids or IV contrast as needed.
  • Ultrasound transducer: Use the high-frequency linear probe with the smallest footprint available.
  • Vein selection: Before starting the procedure, identify the best-candidate vein. Check both arms if needed. Remember the basilic, cephalic, and saphenous veins as possibilities.
  • Ultrasound mapping: Map the course of the vein by sliding the probe up and down the arm. Try to select a straightened segment of the vein.
  • During the IV cannulation procedure:
    • If you cannot find the needle tip, look for it by moving either the probe or the needle. Do not move both at the same time.
    • Once you see the flash of blood, advance the needle and catheter into the vein. Confirm your needle tip in the vein before advancing the catheter.
    • After securing the catheter but before withdrawing the needle, wipe off the ultrasound gel to help with securing the tubing.
  • Practice makes perfect: Practice on adults with large veins. Don’t get frustrated from early difficulties.
William White, MA MD

William White, MA MD

Resident
Department of Emergency Medicine
University of California, San Francisco
William White, MA MD

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Aaron Kornblith, MD

Aaron Kornblith, MD

Assistant Clinical Professor
Department of Emergency Medicine & Pediatrics
University of California, San Francisco