Comment améliorer l'accès veineux difficile en anesthésie pédiatrique ?

Intravenous access is one of the most frequent invasive procedures in medical practice. A step-by-step strategy may improve the success rate. It includes identification of children with potentially difficult intravenous access. Thereafter, different techniques may enhance the reliability of vein puncture and intravenous cannulation: 1) increasing venodilatation, with a tourniquet, using gravity, application of local warmth, or nitroglycerin ointment and trying to prevent pain due to puncture (Emla, N2O); 2) increasing visibility of superficial veins using transillumination or near infrared light devices or ultrasonography. Eventually, when all those techniques failed, a central venous line or an intraosseous infusion should be used. In any case, failure must be anticipated by a prepared alternate strategy.