Vascular Access

THIS POLICY APPLIES TO: Any patient where intravenous (IV) or intraosseous (IO) access is indicated, such as significant trauma, emergent or potentially emergent medical conditions. Recommended for all critical care patients.

RECOGNIZE:

• IV access indicated in cases of significant trauma or emergent medical conditions.
• Access of an existing venous catheter for medication or fluid administration.
• Central venous access in critical patients.
• Patients requiring rapid IV access with:
  • Multisystem trauma with severe hypovolemia
  • Severe dehydration with vascular collapse and/or loss of consciousness
  • Respiratory failure/arrest

EVALUATE:

•  Conduct primary and secondary survey.

Administer Treatment

Vascular Access – Peripheral Extremity

• Don appropriate PPE.
• Use intraosseous (IO) access if life-threatening conditions exist prior to IV catheter placement attempt.
• Select the largest catheter bore based on patient condition and vein size.
• Inspect IV solution for expiration date, cloudiness, discoloration, leaks, or particles.
• Connect IV tubing in a sterile manner; fill drip chamber and flush tubing to remove air bubbles.
• Place tourniquet, select vein, and choose appropriate gauge catheter.
• Prep skin with antiseptic solution, insert needle with bevel up, and advance catheter into vein.
• Remove tourniquet, connect IV tubing or saline lock, and ensure free fluid flow.
• Secure site with sterile dressing and document procedure.

Vascular Access – External Jugular

• Don appropriate PPE.
• Place patient supine with head turned to opposite side (if no cervical injury risk).
• Prep site with antiseptic, align catheter with vein toward same-side shoulder.
• Puncture vein between jaw angle and clavicle; attach IV and secure without circumferential dressing.
• Document procedure, time, and outcome.

Vascular Access – Intraosseous

• Don appropriate PPE.
• Identify insertion site (humeral head, proximal tibia, distal tibia, or distal femur based on patient age and size).
• Prep site with antiseptic solution.
• Insert IO needle at a 60-90 degree angle using manual or EZ-IO device until loss of resistance is felt.
• Remove stylet, aspirate bone marrow if using manual device, and flush with 5 ml NS to confirm placement.
• Administer 0.5 mg/kg Lidocaine (max 40 mg) for pain relief if patient > 3 kg, and flush with 10 ml NS.
• Stabilize and secure needle, adjust flow rate, and document procedure.

Vascular Access – Existing Catheters

• Don appropriate PPE and clean catheter port with alcohol wipe.
• Withdraw 5-10 ml of blood and discard; flush port gently with 5 ml NS.
• Ensure no resistance, infiltration, or patient discomfort before proceeding with medication or fluid administration.
• Document procedure, any complications, and fluids/medications administered.

Vascular Access – Port-A-Cath

• Don appropriate PPE and clean access site with antiseptic.
• Stabilize port chamber and insert Huber needle using sterile technique.
• Withdraw 10 ml for waste, then flush with 10 ml NS.
• If no resistance or infiltration, proceed with administration; otherwise, stop and reassess.
• Secure Huber needle and document procedure.

CONTRAINDICATIONS:

• Peripheral Access: Avoid foot access in diabetics and access on the same side as a dialysis shunt.
• External Jugular Access: Contraindicated in patients ≤ 8 years of age.
• Intraosseous Access: Fracture at proposed site, Osteogenesis Imperfecta, infection at site, prior IO insertion or joint replacement at site.
• Existing Catheter Access: None specific, but assess for clots or dislodgement.

Transport Considerations

None

Information

External Jugular Vein Cannulation: Indicated for critically ill patients > 8 years needing IV access when peripheral or IO access is not feasible. Can be attempted first in life-threatening events where other access is not obtainable.

Other Populations

• EZ-IO contraindicated for patients < 3 kg; use manual IO for these patients.