Safetots.org

Safe Anesthesia for Every Child

Can´t Cannulate – Failed Venous Access (10Cs)

This page is part of the Safetots Crisis SOPs, a framework for prevention and treatment of the most relevant crisis situations in pediatric anaesthesia.

←  previous (Can Intubate – Can’t Oxygenate)      |       next (Anaphylaxis)  →

Summary

Intra-osseous access is the access of choice in life threatening emergencies

Background

  • venous access in children can be difficult resulting in multiple attempts and may fail
  • delays in obtaining venous access can result in morbidity particularly during emergencies
  • those most at risk are young children, the chronically ill, obese or premature infants
  • intra-osseous access has no reported associated mortality in contrast to emergency central venous access

Prevention

  • careful clinical evaluation and preparation (patient, team, equipment and environment)
  • maintain hydration (short fasting times)
  • use topical anesthesia for awake cannulation

Treatment

  • use the vein you can see
  • call for assistance
  • failed conventional venous puncture may require alternative venous access techniques (ultrasound, vein light, vein viewer or others) and operator
  • intra-osseous access is the access of choice in life threatening emergencies

Post Care

  • ensure secure taping of successful venous access
  • consider establishing longterm central venous access (PICC, port, Broviac, Hickmann lines)

References

  1. Nafiu OO, Burke C, Cowan A, Tutuo N, Maclean S, Tremper KK. Comparing peripheral venous access between obese and normal weight children. Paediatr Anaesth 2010; 20: 172-6.
  2. de Graaff JC, Cuper NJ, Mungra RA, Vlaardingerbroek K, Numan SC, Kalkman CJ. Near-infrared light to aid peripheral intravenous cannulation in children: a cluster randomised clinical trial of three devices. Anaesthesia 2013; 68:835-45.
  3. Triffterer L, Marhofer P, Willschke H, Machata AM, Reichel G, Benkoe T, Kettner SC. Ultrasound-guided cannulation of the great saphenous veinat the ankle in infants. Br J Anaesth. 2012;108: 290-4.
  4. Rothbart A, Yu P, Müller-Lobeck L, Spies CD, Wernecke KD, Nachtigall I. Peripheral intravenous cannulation with support of infrared laser vein viewing system in a pre-operation setting in pediatric patients. BMC Res Notes 2015; 8: 463.
  5. Weiss M, Gerber A. The substitute for the intravenous route. Anesthesiology 2001; 95: 1040-1.
  6. Schwartz D, Raghunathan K. Difficult venous access. Paediatr Anaesth 2009; 19: 60.
  7. Weiss M, Henze G, Eich C, Neuhaus D. [Intraosseous infusion. An important technique also for paediatric anaesthesia]. Anaesthesist 2009; 58: 863-75.
  8. Neuhaus D, Weiss M, Engelhardt T, Henze G, Giest J, Strauss J, Eich C. Semi-elective intraosseous infusion after failed intravenous access in pediatric anesthesia. Paediatr Anaesth 2010; 20: 168-71.
  9. Weiss M, Engelhardt T. Cannot cannulate: bonulate! Eur J Anaesthesiol 2012; 29: 257-8.
  10. Eich Ch, Weiss M, Neuhaus D et al. HE Handlungsempfehlung zur intraossären Infusion in der Kinderanästhesie. Anästh Intensivmed 2011; 52: S46-S52.

See all Cs:

Learn about …

Explore …