Strategies to Facilitate Intravenous Access for Electroconvulsive Therapy Procedures in Pediatric and Neurodivergent Patients: A Case Series

<b><i>Introduction:</i></b> Electroconvulsive therapy (ECT) is an effective treatment for severe and treatment-resistant psychiatric disorders, particularly depression and catatonia. ECT requires intravenous (IV) access, which can pose a barrier for pediatric patients and those with neurodevelopmental disorders who may have difficulty tolerating IV placement. This case series highlights individualized pharmacologic and nonpharmacologic strategies that facilitate IV placement in pediatric and neurodivergent patients receiving ECT. <b><i>Methods:</i></b> We reviewed the medical records of five patients aged 14-27 who required ECT but experienced barriers to tolerating IV placement and described strategies used to overcome these limitations. <b><i>Results:</i></b> We describe five strategies: (1) oral anxiolytic premedication, (2) planned physical restraint, (3) intramuscular (IM) ketamine induction, (4) inhalational sevoflurane anesthesia, and (5) placement of an implanted venous access device. Using these strategies, all patients were able to tolerate IV placement and ECT treatment. Consistent treatment protocols, multidisciplinary planning, and engagement of outpatient care teams facilitated the success of these interventions. <b><i>Conclusions:</i></b> Pediatric and neurodivergent patients face unique barriers to ECT, particularly related to IV placement. Our case series demonstrates that individualized, multidisciplinary approaches can enable successful ECT treatment. These findings underscore the importance of adaptive strategies to promote health equity and ensure access to effective psychiatric interventions in special needs populations.