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imperfecta, and osteopetrosis. Complications are rare and have been reported in
less than 1% of patients. These have included extravasation, epiphyseal injury,
fracture, compartment syndrome, fat embolism, and thrombosis (see Chapter 130
Procedures ).
Peripheral venous access provides an adequate route for prearrest
resuscitations. Veins of the hands, forearm, and ankle are most commonly used.
Prolonged unsuccessful attempts at IV access in critically ill or injured children
delay fluid or medication administration as well as interfere with other lifesaving
procedures; use of the IO should not be delayed. Recent advances in the use of
bedside ultrasound by the emergency clinician have increased the placement of
ultrasound-guided peripheral IVs, especially in patients with difficult IV access.
An IV escalation plan should be developed and in place (see Chapter 131
Ultrasound ).