Vascular access, fluid resuscitation, and blood transfusion in pediatric trauma

Abstract

Trauma care in the general population has largely become protocol-driven, with an emphasis on fast and efficient treatment, good team communication at all levels of care including prehospital care, initial resuscitation, intensive care, and rehabilitation. Most available literature on trauma care has focused on adults, allowing the potential to apply concepts from adult care to pediatric care. But there remain issues that will always be specific to pediatric patients that may not translate from adults. Several new devices such as intraosseous (IO) needle systems and techniques such as ultrasonography to cannulate central and peripheral veins have become available for integration into our pre-existing trauma care system for children. This review will focus specifically on the latest techniques and evidence available for establishing intravenous access, rational approaches to fluid resuscitation, and blood product transfusion in the pediatric trauma patient.

Keywords: Pediatric; resuscitation; transfusion; trauma.

Figure 1

Flow through a pipe, adaptation of Hagen-Poiseuille law (modified from calctool.org)

Figure 2

J-Tip air-powered injection system, Jtip.com

Figure 3

Central IV line sites, from the pediatric emergency medicine resource

Figure 4

(a) Drawing IO line, (b) proximal tibia IO line, (c) EZ-IO drill; adapted from Ramaiah and Sharar[14]

Figure 5

Ultrasound images of femoral and internal jugular venous sites

Figure 6

Advanced trauma life support resuscitation algorithm

Figure 7

Broselow length-based resuscitation tape guide for pediatric patients, adapted from pediatric advanced life support

Figure 8

Suggested transfusion practice in massive hemorrhage (adapted from Dehmer et al.[32] with permission and modified from Barcelona et al.[34])