Immediate Questions

A. What is the nature of patient's illness, and what other locations or vascular access should be considered? Alternative therapies or regimen may be attempted in some medical conditions or clinical situations (eg, oral or nasogastric tube rehydration can be considered in mildly dehydrated, hemodynamically stable patients). Always have a well-formulated plan for vascular access; do not waste time looking for small peripheral veins. Children requiring immediate IV access (eg, hypotension with shock) should undergo intraosseous cannulation or percutaneous femoral line placement in the absence of large peripheral veins (eg, saphenous or antecubital). Always consider the possibility of a bleeding diathesis or coagulopathy before inserting a central venous line.

B. Is there a history of chronic illness, prolonged hospitalization, or known difficult IV access? What routes of access were used on other occasions? Chronically hospitalized patients often lose usable peripheral veins after multiple IV insertions and venipunctures.

III. Differential Diagnosis. Peripheral IV access may be poor in the following situations:

A. Chronic Illness (eg, sickle cell disease).

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