Modern way of vascular access in critical state of children

To provide a vascular access is the main task during the first minutes of resuscitation, but it should not interrupt the chest compression or ventilation. Vascular access includes the catheterization of peripheral vein or intraosseous space. The European Resuscitation Council in 2005 has recommended to establish the practice of intraosseous access (IOA) during resuscitation. The following updates of the European Resuscitation Council Recommendations (2010, 2015) has also considered that it necessary to use intraosseous access during cardiopulmonary resuscitation. The emergency physician should use intraosseous access as useful alternative to peripheral venous access. Intraosseous access has all advantages of central venous access, but it is much easier and faster. Consequently, in case of cardiac arrest and apnoea as well as decompensated shock, when the introduction of adrenaline and/or infusion solutions is the first-line treatment, the most appropriate vascular access is intraosseous one. Provided that the procedure is performed in compliance with aseptic rules, the risk of infectious complications is very low. However, intraosseous access should be transitional vascular access and should be removed as soon as possible. Its use must never exceed 24 hours.