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 in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

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

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC