IV/IO Access for Neonate Resuscitation

For neonatal resuscitation, we have the option of IV or IO route for med administration. But even the 25 mm (Blue) IO needle is likely to be too large for a child under 24 hrs of age. Are there any limitations on our options for IV placement? I know there are a number of unusual spots utilized in infants by NICU staff, etc. but are we able to attempt cranial, saphenous, jugular, sites etc. for IVs given we usually haven't practiced or trained on them?

Good day! Thank you for your question!

For neonates, we would recommend the 15mm (Pink) EZ-IO needle (3-39kg) given it’s smaller needle length. For these types of patients, paramedics will still need to be cautious as to how far they insert the needle. As per the companion document on pediatric IO insertions:

"Gently drill, immediately release the trigger when you feel the loss of resistance as the needle set enters the medullary space".

As a result, paramedics may not get the entire IO needle inserted before they should stop. This terminology is different for the adult IO insertion.

With regards to IV sites for this group of patients, the companion document generally speaks to, “upper and lower extremity veins depending on your Base Hospital’s authorization”. In clarification with the medical directors, because paramedics have not been educated on these sites for this population, we do not support the use of cranial, saphenous and jugular IV sites. Instead, we do support the use of common IV/IO sites as per the medical directives and paramedic IV/IO education.

Take care!

CEPCP