Multiple Choice

What is the most effective route of administration of epinephrine during neonatal resuscitation?

A. Intraosseous catheter
B. Peripheral IV catheter
C. Endotracheal tube
D. Umbilical vein catheter

D. Umbilical vein catheter

The preferred route of epinephrine administration is through an umbilical vein catheter. This approach can reliably deliver epinephrine to the central venous system. Intraosseous administration is also acceptable, but less desirable. A peripheral intravenous catheter is not recommended. In fact, providers should not even attempt to place a peripheral IV catheter during this critical time. Epinephrine can be administered through the ETT if an umbilical vein catheter is not yet available (i.e., while an umbilical vein catheter is being placed). Keep in mind that it is difficult to predict the amount of epinephrine that reached the bloodstream when the drug is administered through an ETT. As such, umbilical vein administration and even intraosseous administration are preferred over ETT administration.

References
1. Rajani AK, Chitkara R, Oehlert J, Halamek LP. Comparison of umbilical venous and intraosseous access during simulated neonatal resuscitation. Pediatrics. 2011;128(4):e954-958. 10.1542/peds.2011-0657