Date of Award

Spring 5-8-2020

Document Type

DNP Project

Project Team Faculty Member

Debra Jenkins

Project Team Faculty Member

Rebecca Collier


pediatric, algorithm, intraosseous, vascular, IO, anesthesia


In pediatric patients undergoing elective surgery, anesthesia is commonly induced via mask inhalation followed by peripheral IV placement before proceeding to airway management. However, IV access is often unpredictable and difficult to obtain in pediatric patients, with attempt success between 35% to 74%. During IV attempts, many dangerous clinical situations can occur amid limited options to deliver necessary medications. Failure to attain IV access may ultimately require extremes such as CVC placement or procedure cancellation. In this project, a difficult vascular access algorithm including intraosseous devices as an alternative was developed based on current evidence, existing algorithms, and implementation site needs. The algorithm was approved as appropriate use by the device manufacturer. Anesthesia providers were educated on intraosseous use, contraindications, and complications for elective pediatric anesthesia and supplied copies of the algorithm. Seven anonymous surveys were then collected, and discussion followed. Although discussion revealed barriers precluding site agreement to implement the project algorithm, this project made a positive impact on the anesthesia group. Providers unanimously reported an increase in knowledge and comfort using intraosseous devices for pediatric elective anesthesia. Providers also reported that they would more rapidly seek IV placement assistance and utilize alternative methods to expedite vascular access.

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