Intravenous cannulation in infants can be a vex-ing ordeal. This is particularly true for infants who have spent weeks in a neonatal intensive care unit and have few unpunctured veins left. Even healthy 1-year-old children can prove a challenge because of extensive subcutaneous fat. Venous cannulation usu-ally becomes easier after 2 years of age. The saphe-nous vein has a consistent location at the ankle and an experienced practitioner can usually cannulate it even if it is not visible or palpable. Transillumination of the hands or ultrasonography will often reveal previously hidden cannulation sites. Twenty-four-gauge over-the-needle catheters are adequate in neo-nates and infants when blood transfusions are not anticipated. All air bubbles should be removed from the intravenous line, to reduce the risk of paradoxi-cal air embolism from occult patent foramen ovale. In emergency situations where intravenous access is impossible, fluids can be effectively infused through an 18-gauge needle inserted into the medullary sinusoids within the tibial bone. This intraosseous infusion can be used for all medications normally given intravenously, with almost as rapid results , and is considered part of the standard trauma resuscitation (ACLS) protocol when large-bore intravenous access cannot be obtained.
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