Peripheral IV Access in Infants

Preferred Peripheral IV Sites by Age

The American Academy of Pediatrics recommends using the upper extremities as the primary sites for peripheral IV access in infants, with the scalp as an acceptable alternative in neonates and young infants, and reserving the lower extremities for when upper sites are unavailable 1
In neonates and young infants, the scalp veins are acceptable and commonly used sites due to their visibility and accessibility, but upper extremity sites remain the preferred first choice when accessible 1
The American Academy of Pediatrics suggests that lower extremity sites should be avoided when possible and replaced with upper extremity access as soon as feasible in infants 1
In older infants, upper extremity sites are strongly preferred over lower extremity placement, and if a lower extremity catheter was placed, it should be replaced to an upper extremity site as soon as possible 1

The Centers for Disease Control and Prevention recommends that the anterolateral thigh is the preferred site for infants and young children receiving intramuscular injections, and the deltoid muscle should not be used in infants 2, 3, 4, 5
The American Academy of Pediatrics suggests administering intramuscular injections at a 90-degree angle to ensure proper intramuscular placement, although this specific guideline is not from a primary medical society 6

For infants requiring parenteral nutrition or therapy exceeding 6 days, the American Academy of Pediatrics considers a peripherally inserted central catheter (PICC) or midline catheter rather than repeated peripheral attempts 1
The American Academy of Pediatrics advises avoiding femoral vein access when other sites are available due to higher infection risk 1
The European Society for Clinical Nutrition recommends that for central venous catheters, the catheter tip should be positioned outside the pericardial sac to prevent cardiac tamponade—a life-threatening complication particularly in neonates 7

The Infectious Diseases Society of America recommends evaluating the catheter insertion site daily by palpation through the dressing to detect tenderness, and removing peripheral catheters if signs of phlebitis develop 1
The American Society of Anesthesiologists suggests that routine catheter changes at 72-96 hours are not recommended—only change when clinically indicated, and all cannulae must be flushed after use to maintain patency 9

The American Academy of Pediatrics advises never using steel needles for administering fluids or medications that could cause tissue necrosis if extravasation occurs 1
The American Society of Anesthesiologists recommends avoiding insertion in limbs with lymphedema except in acute emergencies due to increased infection risk, and not using peripheral IV access for high osmolality solutions or access needs exceeding 2 weeks 9
The American Society of Anesthesiologists suggests that the smallest practical cannula size should be used to minimize vein trauma 9