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Vascular (venous) access for pediatric resuscitation and other pediatric emergencies

Susan B Torrey, MD
Section Editor
Gary R Fleisher, MD
Deputy Editor
James F Wiley, II, MD, MPH


Establishment of reliable vascular access is a critical step in pediatric resuscitation, but it can be difficult to obtain in a critically ill infant or child. Successful resuscitation is more likely if vascular access is achieved within the first few minutes [1]. This topic will discuss the selection of a site for vascular access, as well as techniques for peripheral and central percutaneous access and venous cutdown.

Intraosseous cannulation and ultrasound-guided vascular (venous) access are discussed separately. (See "Intraosseous infusion" and "Principles of ultrasound-guided venous access".)


The preferred venous access site during pediatric resuscitation is the largest, most accessible vein that does not require the interruption of resuscitation [2]. Intraosseous cannulation is an acceptable alternative as a first attempt at vascular access in a child with full cardiopulmonary arrest or severe shock. (See "Intraosseous infusion", section on 'Indications'.)

Peripheral venous access should be attempted before attempting other forms of vascular access if peripheral veins can be readily seen or palpated.

Attempts at peripheral and central venous access in the head, neck, and chest should be limited during CPR to avoid interruption of ventilation and chest compressions.

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Literature review current through: Sep 2017. | This topic last updated: Aug 08, 2016.
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