[size=6]A 5-week-old 3 kg infant is in the ED with bilious emesis. The infant is lethargic and dehydrated. The ED has not been able to obtain peripheral IV access. What is the best next step to secure urgent vascular access?

 

a Saphenous vein catheter

 

b Umbilical vein catheter

 

c Intraosseous access

 

d Internal jugular vein catheter[/size]

C

C

C

c

[b]correct answer

c Intraosseous access[/b]

 

In an infant with dehydration, obtaining timely peripheral access may not be possible. Intraosseous placement in the proximal tibia or the proximal humerus is the most expeditious means to gain vascular access. A saphenous vein catheter would likely require a cutdown and would be more prolonged. Umbilical vein access in a 5-week-old infant is not possible since it has already closed. Percutaneous access of the internal jugular vein is an option but may be difficult without sedation and will take longer than an intraosseous line placement.