Care of the pediatric critically ill patient includes obtaining appropriate intravenous (IV) access for secure, safe, and timely medication administration. Many options exist for IV access but risks and benefits of each access type should be considered. Various vascular access devices are used in the critical care setting. Peripheral access is often gained in distal veins yet—particularly in pediatric patients—peripheral devices have a high first-attempt failure rate and short patency time, making them not ideal for long-term drug administration. Central venous access devices (CVADs) and peripherally inserted central catheters provide direct administration to the central venous system and can allow for more stable long-term infusion needs. Midline catheters are inserted peripherally but terminate distal to a CVAD at or below the axillary vein.

Several medication properties should be considered when deciding on central versus peripheral administration, including osmolarity, pH, and concentration. The cumulative risk of phlebitis and the...

You do not currently have access to this content.