Paediatric Access Options in Cardiac Arrest • LITFL • CCC

1	2	3
Method	Advantage	Disadvantage
Peripheral intravenous	Least invasive Possible use of scalp veins (easier) Adrenaline dose: 10mcg/kg	Can be difficult due to low calibre Time-consuming Unable to provide high volume fluid resuscitation High risk extravasation
Intraossesous	Rapid access Concurrent access to blood sampling Multiple sites possible (tibia, femur, humerus, sternum) Often stable Same dosing as per iv	Potential for Fracture Infection Compartment syndrome Vascular rupture Short-term whilst awaiting definitive access
Central venous line	Definitive access Low infection risk Able to sample, infuse and resuscitate via this line	Requires significant preparation and insertion time Risk of pneumothorax Risk of retroperitoneal bleed Risk of non-compressible bleeding (femoral)
Intramuscular	Immediate access by needle/syringe Dose of 100mcg/kg adrenaline	Slow effect due to absorption time, esp. if slow circulation No capacity to administer fluid or blood sampling
Endotracheal	Rapid administration without intravenous /io access Adrenaline dose 100mcg/kg Variable absorption Direct absorption	No sustainable in cardiac arrest Temporising measure in resuscitation No fluid or blood sampling possibilities
Venous cut-down	In severely shutdown patients Preceded IO as a technique Direct visualisation and access of large peripheral vessel Facilitates large bore access for fluid resuscitation	Time consuming Requires operator experience
Umbilical vein	Uncommon in infants More in neonates Rapid iv access Catheterisation allows sampling, monitoring and fluid resuscitation	No available after 48hrs to 5 days Risk of infection Technically difficult Time-consuming with preparation time Risk of UV thrombosis/phlebitis and omphalitis

Critical Care

Compendium

…more CCC

Chris Nickson

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Critical Care

Chris Nickson

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