A 4-year-old in cardiac arrest has failed peripheral IV access after 2 attempts and 90 seconds. Peripheral veins are not visible. What is the most appropriate next step for vascular access?
- A Central venous catheterization via femoral vein
- B Intraosseous needle insertion at proximal tibia ✓
- C External jugular vein cannulation
- D Continue peripheral attempts for another 2 minutes
Correct answer: B. Intraosseous needle insertion at proximal tibia
Explanation
In pediatric cardiac arrest with failed IV access after 90 seconds, intraosseous access is the recommended immediate alternative. The proximal tibial plateau is the preferred site in children. IO access provides rapid, reliable delivery of resuscitation drugs and fluids. Peripheral attempts should not delay IO placement in arrest. Central access is technically difficult during CPR.
Reference: Pediatric Advanced Life Support Provider Manual, American Heart Association 2020 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.