What's the minimum iv access you would have....

[urge]

for a scoliosis repair/rods in a 12y/o with poor veins? Average surgeon.

Anybody can do it with two cordis and two 14g ivs. That's not the point. I want to know what is your bare minimum to let the surgeon start.

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[Planktonmd]

I would induce with whatever access I can get even a 22, then place a triple lumen in the right IJ and go ahead.
My transfusion and volume replacement approach will be greatly dependent on the skill of the surgeon.
It's all about anticipating what blood loss is going to happen and starting to correct the volume early.

for a scoliosis repair/rods in a 12y/o with poor veins? Average surgeon.

Anybody can do it with two cordis and two 14g ivs. That's not the point. I want to know what is your bare minimum to let the surgeon start.

 

[veetz]

I would induce with whatever access I can get even a 22, then place a triple lumen in the right IJ and go ahead.
My transfusion and volume replacement approach will be greatly dependent on the skill of the surgeon.
It's all about anticipating what blood loss is going to happen and starting to correct the volume early.

Induce, look for better peripheral IV access, as veins often become more prominent with the vasodilation. If no go, then RIJ. I would like atleast 2 nicely-working 18g's.

 

[IlDestriero]

Induce, look for better peripheral IV access, as veins often become more prominent with the vasodilation. If no go, then RIJ. I would like atleast 2 nicely-working 18g's.

It depends on if the patient has idiopathic scoliosis or neuromuscular. Idiopathic might be fine with a 22 for the tiva and an 18 for fluid/products. Neuromuscular would get the 22 and ideally 2 18/16 or a double/triple lumen IJ and an Aline. I like central lines in the neuromuscular kids because they tend to both bleed like hell and 3rd space more than the idiopathic kids. The CVP can also come in handy with pressor/volume decision making. I use amicar and a cell saver for them as well.

 

[gasaddict54]

It depends on if the patient has idiopathic scoliosis or neuromuscular. Idiopathic might be fine with a 22 for the tiva and an 18 for fluid/products. Neuromuscular would get the 22 and ideally 2 18/16 or a double/triple lumen IJ and an Aline. I like central lines in the neuromuscular kids because they tend to both bleed like hell and 3rd space more than the idiopathic kids. The CVP can also come in handy with pressor/volume decision making. I use amicar and a cell saver for them as well.

amicar too? I need to read up on NM scoliosis apparently......I would have said 2 excellent 18g min

 

[ultm8frisbee]

Drop in a triple lumen IJ and get going. You can get volume in quick enough for a spine case through the 16 ga port. Although you can loose a lot of blood in these cases, its never abrupt and usually a "ooze". I'd also proceed with a induction IV and any reliable 18ga.

 

[jetproppilot]

for a scoliosis repair/rods in a 12y/o with poor veins? Average surgeon.

Anybody can do it with two cordis and two 14g ivs. That's not the point. I want to know what is your bare minimum to let the surgeon start.

Scoliosis surgery isnt the arena for minimums.

 

[urge]

How about two 20g ivs?


Plus, subclavian anyone?

 

[Planktonmd]

How about two 20g ivs?


Plus, subclavian anyone?

Why not?
Although a subclavian may become obstructed in the prone position.

Why do you need 2 peripherals and a central line?

 

[Masseter Spasm]

Sounds like something that I would feel comfortable doing with two 20 guage IV's.

 

[sevoflurane]

22G or higher to go off to sleep. Then 16G. No central access.

 

[dhb]

Why a TRIPLE LUMEN?? what king of shiite are you going to be infusing?
I would want 2 ivs at least one 18g if you can only get a 22g then a central line 14 or 16g.

 

[Planktonmd]

Why a TRIPLE LUMEN?? what king of shiite are you going to be infusing?
I would want 2 ivs at least one 18g if you can only get a 22g then a central line 14 or 16g.

He said the kid had "poor veins"

 

[dhb]

A triple lumen is still overkill

 

[Idiopathic]

We do these with motors and amicar and they bleed a lot: I used proposal, neo, amicar and remi infusions on my last one and id feel a lot more comfortable with central access in that case. I think if it was a more straightforward general then i could be talked into two 18s

I think ultimately i hate relying on PIVs for a TIVA where it will be near impossible to get another IV urgently if the case should arise

 

[Pilot Doc]

for a scoliosis repair/rods in a 12y/o with poor veins? .

How many kg's. 12yo could be 20-60kg.

 

[SleepIsGood]

we did these with 1 22g....usually to induce. then would use that line for the fentanyl infusion. Stopped using remi infusion for this d/t opiod ind hyperalgesia.

then put 1, but usually 2, 18 g's.

Never used amicar,etc. Kids are pretty tolerant...even if they loose about 1 liter of blood. we did once do acute normovol. Hemodiluation (worked great).