By veronica L Gunn; Christian Nechyba; Johns Hopkins Hospital. Children's Medical and Surgical Center.; MD Consult LLC
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B. Dorsalis pedis artery: Puncture the artery at the dorsal midfoot between the first and second toe while holding the foot in plantar flexion. G. CENTRAL VENOUS CATHETER PLACEMENT  1. Indications: To obtain emergency access to central venous circulation, to monitor central venous pressure, to deliver high-concentration parenteral nutrition or prolonged IV therapy, or to infuse blood products or large volumes of fluid. 2. Complications: Infection, bleeding, arterial or venous laceration, pneumothorax, hemothorax, thrombosis, catheter fragment in circulation, air embolism, and atrioventricular fistula.
A. Dosage: Dilute 20% NAC solution to 3% solution with D5 W. 2 micromillipore filter.  •b. Check plasma acetaminophen level at 24hr. Small risk of anaphylaxis with IV NAC. NOTE: Oral preparation of NAC is not pyrogen free and should be used only as an IV preparation under the guidance of the hospital pharmacy. Alcohols  Ethanol (often >50% in mouthwashes, colognes, and aftershave), isopropanol, methanol (windshield wiper fluid), ethylene glycol (antifreeze) Blindness (methanol), inebriation, central nervous system (CNS) depression, seizures, coma, hypoglycemia, metabolic acidosis, renal failure (ethylene glycol) NOTE: Toxic effects are primarily the result of the metabolites of methanol and ethylene glycol.
3. Complications: Infection, bleeding, hematoma of femoral triangle, thrombosis of vessel, osteomyelitis, and septic arthritis of hip. 4. Procedure ( Fig. 3-3 ) a. Hold child securely in frog-leg position with the hips flexed and abducted. b. Prepare area in sterile fashion. c. Locate femoral pulse just distal to the inguinal crease (note that vein is medial to pulse). 75 cm into the groin. Aspirate while maneuvering the needle until blood is obtained. d. Apply direct pressure for minimum of 5 minutes.