Vascular Access Clinical Pathway — Emergency Department

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Related Pathway

Vascular Access, Inpatient

Peripheral IV Access Required

Conserving IVF During Shortage

Emergent

Two attempts
Consider simultaneous US guided IV attempts
Consider immediate IO access
Resuscitation Room Considerations

IV Escalation

US guided IV if not attempted
Refer to alternatives to IV access
Notify Attending

Urgent

Pain Control
Assess for DIVA

DIVA score ≥ 3
History of difficult IV access

EPIC, patient/caregiver

Not Difficult

Initial clinician: 2 attempts
May use special techniques

Difficult

US guided IV - 2 attempts
or
Senior Clinician: Clinician with > 2 years of experience, consult IV team if requested by caregiver 1 attempt
May use special techniques

Notify Attending
Discuss and document plan

US guided IV
Senior US guided IV provider
Two attempts

Additional IV Attempts

Must notify Charge RN
IV Team
IR US guided IV

PAIN CONTROL
Every Time (Except Emergent IV)

Distraction/Child Life
Sucrose
LMX
Pain Ease
Buzzy

SPECIAL TECHNIQUES

Hot Packs
ACCU Vein
Transilluminator

ALTERNATIVES TO IV

Oral, NG, GT Route
- Hydration
- Medications
IM Route
- Medications
Midline Catheter
Central Line Placement

DIVA Scoring Tool

Predictor	0 Points	1 Points	2 Points
Visible Vein	Visible	-	Not Visible
Palpable Vein	Palpable	-	Not palpable
Age	≥ 36 months	12-35 months	<12 months

Resources for Catheter Choice/Placement
- Management of Peripheral IV
- Management of Central Line

Emergency Department Catheter Sizes

Posted: October 2013
Last Revised: October 2024
Authors: A. Chen, MD; A. Vinograd, MD; J. Lavelle, MD; MK. Abbadessa, ACCNS-P; S. Gaines, RN

Evidence

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Emergency Department Clinical Pathway for Children who Require Vascular Access

Evidence

Emergency Department Clinical Pathway
for Children who Require Vascular Access