What are the options for vascular access in children?
There are many options for vascular access in children. Depending on the situation at hand, some might not be as available or achievable as others. Conditions permitting, peripheral venous access is generally preferred over other means. Antecubital, hand, wrist, foot, and ankle veins are the most popular access sites. Saphenous veins in the ankle are deep but often accessible. External jugular veins are also reliably accessible but require difficult positioning of the child to be successful. Scalp veins are potential sites of access in infants but might be difficult to access while managing the patient’s airway.
Central access sites include bone marrow, femoral veins, and subclavian veins. Subclavian access should be attempted only by those skilled in the procedure. Consider intraosseous (IO) access early when venous access cannot be obtained, especially in the case of apnea and pulselessness in an infant.