Failed intravenous access in children

Securing intravenous access in children can, on occasion, be difficult, time-consuming and frustrating. Unhurried preoperative examination for possible cannulation sites, avoidance of long starvation times and the use of adjuncts including topical local anaesthetic creams and oral sedatives improve success rates. Despite these measures, failure of peripheral cannulation will still occur. A range of alternative methods to access the circulation including intraosseous needles and central venous cannulation are described in outline. The role of each alternative technique in a range of clinical situations is discussed along with their advantages and disadvantages.