The preferred route for administering fluids and drugs is via a peripheral intravenous line enabling prolonged infusion and high flow rates. In children however, peripheral access may be difficult, and although central access may be attempted this is often difficult and hazardous especially in the very young. An effective, rapidly obtained alternative to peripheral venous access is the intraosseus route. It is recommended for children up to the age of six years. Fluids and drugs may be infused rapidly, and samples of marrow may be obtained for routine investigations such as glucose, urea and electrolytes and full blood count. The intraosseous route however should not be used for long term access and should be replaced with an intravenous cannula when appropriate.
If neither intravenous or intraosseous access can be obtained then certain drugs such as lignocaine, epinephrine, atropine and naloxone (LEAN drugs) may be administered via the endotracheal tube. Ten times the usual dose should be used and injected deep into the bronchial tree, with a fine bore cannula, then flushed with an equal volume of saline.
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