There is no more exasperating situation than the inability to establish intravenous (IV) access in a critically ill child. Yet this predicament confronts physicians. It is not uncommon for a child to come to an emergency room in severe shock, with no visible or palpable veins, or for the only venous access to a child to be lost in an emergency. These catastrophes occur even in controlled environments such as the operating room or the intensive care unit. The rapid establishment of central venous access is a skill that is rapidly lost without practice, and yet few physicians outside of their residency have the opportunities to maintain these skills. Surgical exposure of a vein is a time-consuming process that exhausts valuable lifesaving minutes in an emergency. Unskilled attempts at jugular or subclavian vein punctures can result in further catastrophes.
Over the last few years we have seen the rejuvenation of