Clinical Pathway for Vascular Access Inpatient Non-ICU Setting
Child Requiring IV Access in the Inpatient Setting
Review history of difficult access, available in FYI banner- Considerations for:
Peripheral Access
Non-Urgent
Urgent/Emergent
Non-Difficult Vascular Access or Unknown
Known Difficult Access
- Initial attempt by clinician skilled in PIV placement if available
- Immediate call to unit-based resource or VAS
- US-guided PIV recommended for known difficult access
2 attempts by clinician skilled in PIV placement
US-guided PIV if trained provider available
Failed or unavailable
Failed or unavailable
Failed
- Consult IR, ICU
- Consider alternatives to IV (IM, IO)
- Notify attending physician
- Unstable or impending instability
- Critical assessment team
Vascular Access Service (VAS) or unit-based resource atttempt
Failed
Team Huddle (Tier 0)
- VAS, bedside RN and hospital provider
- Fellow and attending if applicable, notify if not available
- Document Tier 0 note as appropriate
- Consider
- Additional PIV attempts to lower extremities, EJ
- Alternatives to IV (PO, NG, IM)
- Consult IR
- Review considerations for central venous access
Vascular Access Obtained
- Daily vascular access assessment on primary team rounds
- Review considerations for central venous access and catheter selection
- Consider antimicrobial lock if eligible