1. Core Principles of Vascular Care

The administration of infusion therapy and the management of vascular access devices (VADs) must be governed by a structured hierarchy of safety and ethics. These principles apply to all access types, including peripheral, central, intraosseous, subcutaneous, and epidural/intrathecal routes.

• Regulatory Alignment: Clinicians must adhere to the specific legislative and regulatory framework of their jurisdiction (national, state, or provincial).
• Organizational Standards: Every clinical action must be traceable to formal institutional policies, standardized protocols, or written orders.
• Ethical Advocacy: Practitioners are the primary defenders of patient autonomy and dignity. Decisions should prioritize safety over efficiency and remain free from commercial influence or conflicts of interest.

2. Pediatric and Neonatal Considerations

Pediatric vascular access requires a departure from adult “one-size-fits-all” approaches due to unique physiological and developmental requirements.

Physiological Precision

• DEHP Exposure: Equipment, particularly administration sets, should be free of Di(2-ethylhexyl)phthalate (DEHP) to minimize plasticizer-related risks in neonates and children.
• Volume Accuracy: Infusion pumps must be capable of delivering precise, low-volume rates. Calculations should be strictly based on age, weight, or body surface area.
• Dermatologic Fragility: In preterm infants, the skin barrier is underdeveloped, increasing the risk of systemic absorption of antiseptics and mechanical injury. Vigilant monitoring for chemical burns and systemic toxicity is mandatory.

Technical Enhancements

• DIVA Protocols: For patients with Difficult Intravenous Access (DIVA), ultrasound-guided insertion or near-infrared visualization should be standard practice.
• Non-Traditional Sites: If standard peripheral sites are exhausted, advanced techniques such as the supraclavicular approach to the brachiocephalic vein or tunneled femoral cannulation may be indicated.
• Pain Management: Non-pharmacologic comfort measures are essential to mitigate long-term needle phobia and medical trauma.

3. Obstetric Considerations

Pregnancy alters maternal hemodynamics and pharmacokinetics, necessitating a dual focus on both maternal and fetal safety.

• PICC Risks: Peripherally Inserted Central Catheters (PICCs) in pregnant patients are associated with higher rates of thrombosis and infection due to the natural hypercoagulable state of pregnancy.
• Labor Management: For low-risk patients, indication-only peripheral IV insertion is preferred over routine placement, provided the facility has resources for rapid emergency response.
• Nutritional Support: In cases of Hyperemesis Gravidarum, enteral feeding (nasogastric or nasoduodenal) is the first-line intervention. Parenteral nutrition (PN) should be reserved for cases where enteral methods have failed.

4. Geriatric Considerations

Aging introduces structural changes in the vasculature, including thinning of dermal layers and thickening of the tunica intima, leading to increased vessel fragility.

• Cognitive and Functional Assessment: Prior to authorizing home-based infusion therapy, clinicians must evaluate manual dexterity, cognitive status, and the patient’s ability to identify complications.
• Polypharmacy: Older adults are at high risk for drug–drug interactions. Frequent medication reconciliation is a critical safety component of vascular therapy.
• Dialysis Access: While arteriovenous fistulas (AVFs) are generally preferred, dialysis access decisions should be individualized, balancing life expectancy and frailty against the risks of central vascular access devices (CVADs).

Population-Specific Summary