imperfecta, and osteopetrosis Complications are rare and have been reported in less than 1% of patients These have included extravasation, epiphyseal injury, fracture, compartment syndrome, fat embolism, and thrombosis (see Chapter 130 Procedures ) Peripheral venous access provides an adequate route for prearrest resuscitations Veins of the hands, forearm, and ankle are most commonly used Prolonged unsuccessful attempts at IV access in critically ill or injured children delay fluid or medication administration as well as interfere with other lifesaving procedures; use of the IO should not be delayed Recent advances in the use of bedside ultrasound by the emergency clinician have increased the placement of ultrasound-guided peripheral IVs, especially in patients with difficult IV access An IV escalation plan should be developed and in place (see Chapter 131 Ultrasound )