8 month old baby dies because iv line could not be accessed

An 8month old baby was rushed into my ward with the complaints of diarrhoea and vomiting for 2days.on asssessment , the child was severely dehydrated and clinically pale.the rbs was 5.2mmol/l. temp 37.5,pulse 136bpm and spo2 98%.efforts were made to get an iv line on any part of the but it failed. an NG tube was passed n some fluid given through that route.but the iv line was still difficult to get .child finally passed away because of severe dehydration.assuming you were in my shoes what will u have done?
((HUGS)) I have seen this once in all 35 years that I actually know and saw a child die from dehydration right in front of my eyes. I was covering triage when a non English speaking couple from a Vietnamese community near by ....brought their sick infant. The baby had been sick for a couple of days with diarrhea and vomiting. They used traditional Eastern methods of coining and cupping to cure the infant....staying in their close community. When the grew desperate and the baby grew sicker they sought out Western medicine.This baby was frightening...so pale so quiet. Sunken eyes/fontanelle.....the baby was 2 months old. Furred tongue, limp. I KNEW in a instant with never touching the child we were in trouble.We tried everything. Multiple sticks....we got a couple of peripheral but they blew instantly. I got an anticubital began to bolus and it blew.....I am still upset....Did I push too hard? Is it my fault? I was very careful but it blew. We gave subq fluids but they don't absorb fast enough. I'd be cautious with NG fluidWe did IO and finally a cut down, she was so dehydrated that even the cut down was impossible to cannulate her tiny shut down collapsed veins as this poor little baby slipped right through our fingers. It haunts me....that sweet so very sick baby and her grief stricken parents.I don't know if your facility allows IO's or if you had a physician in your facility. I can tell you are not in the US by your lab value, rbs was 5.2mmol/l, which is 114mg/dl in the US.((hugs)) dehydration is very dangerous. Don't neat yourself up...you did your best.

Intraosseous

IO or cut down if necessary.

Intraosseous was my first thought as well.

When I was in a pediatric ER during clinicals, the hospital used Hylenex when they could not access a vein for fluid replacement so I was able to see a baby with this in her back. The children's hospital they took critical cases to did not have this method, which I thought was interesting. Here is a link: Hylenex® recombinant (hyaluronidase human injection) Indicated for use as an adjuvant for Regional & Local Anesthesia �" Official Site - Hydration

Agree with going IO. What about subcutaneous?

I thought about IO as well. You can only do much. Sometimes they just get to us too late. It's frustrating because you know what could help and it seems simple enough, but it's never that easy. This would be a good case to discuss as a department to come up with a plan on what other interventions to try next time.

IO or Sub Q.

Don't forget about the scalp veins. The skin is thick and I usually need a 22 gauge unless I am going for the vein near the middle of the forehead. Sometimes during an emergency it may be difficult to get to the head but I if I need to get up there with my rubber band tourniquet they better let me up there and they do! . The saphenous vein is also a great option.... hang the limb down to get is to fill with blood, heat pack and then apply tourniquet. Then as stated IO is a great option and once that is in you can work on other options. Hypodermoclysis is an option but not the best choice in an emergency.

What about a central line? Or would that be impossible due to the severity of dehydration?

Same; IO or cut down. Anesthesia or surgery are usually pretty good at getting lines in impossible situations.

One more thing that often helps is to expect that you may get little or no blood return in your flashback chamber. Depending on the device you have you can do a few things to give you a few more clues that you indeed have successfully cannulated a vein. If using a product that you can take the flashback chamber plug off the device...do so. (ie: the Saf-T-Intima and the Braun Introcan will allow you do this. If using for an insyte autogard you will see a flash though the cannula so look for that. Next, if you feel that you have cannulated the vein and can feel that slight pop in..proceed as if you are in the vein and advance......pull back the stylet or slide the cannula in and off the needle (your regular procedure in other words. In a child or infant with severe dehydration or low or no BP you may never get a flashback or may only see a speck of blood. You need to trust your experience and it it feels right just proceed. I can't tell you how many times this has happened to me. Sometimes I will get some blood after I threaded it and take the stylet out and other times I will get none and just flush and then I know its good and I started it successfully without ever seeing a speck of blood.I have had this happen on adults as well so it is not exclusive to children or infants. Another option is to use a bedside Ultrasound and go for the basiclic, or brachial veins .Of course, you will need to have someone with experience to do so