If a newborn requires epinephrine and peripheral venous access fails, what should be done next?

When a newborn requires epinephrine and peripheral venous access has failed, cannulating the umbilical vein is the most appropriate next step. The umbilical vein provides a reliable route for administering medications rapidly, which is crucial in emergency situations such as resuscitation. It allows for effective delivery of medications directly into the systemic circulation, and since the umbilical vein is a large and centrally located vessel, it can accommodate the rapid infusion needed for immediate treatment.

In critical scenarios involving newborns, it is essential to deliver lifesaving medications efficiently and without delay. Cannulating the umbilical vein bypasses potential complications and slower response times associated with attempting further peripheral access or deferring intervention altogether. This method is also beneficial because it minimizes the stress on the newborn that can occur when multiple attempts at peripheral IV access are made.

Other options like injecting the drug directly into a vein could imply the need for invasive procedures that may not be immediately feasible. Deferring drug therapy and transport would increase the risk of deterioration in the newborn's condition, while performing intubation, though important in certain cases, does not directly address the need for immediate medication administration. Thus, utilizing the umbilical vein for access ensures timely delivery of epinephrine and