Intraosseous infusion: Difference between revisions

Revision as of 13:59, 18 November 2022

Intraosseous infusion in cases where it is necessary to ensure access to the bloodstreamn which cannot be ensured even with a line. All drugs, including solutions and blood derivatives, can be administered intraosseously. The speed of onset of action is comparable to central venous access. It is most often used in pre-hospital care, in hospitals it can help in urgent situations, especially if it is not possible to cannulate the central vein reliably and quickly.

A certain disadvantage is the painful application, the need for special cannulae and the limited time of possible use - 6-12, exceptionally a maximum of 24 hours of use are mentioned. The pain during bone penetration is overestimated, it is comparable or less than skin puncture with a wider cannula (Gronych 2014).

Indication

impossibility of inserting an intravenous cannula (two unsuccessful attempts in an emergency situation)
cardiopulmonary resuscitation
shock of any etiology
status epilepticus

[[

Intraosseous Infusion

|250px|thumb|Intraoseální infúze kontrastního roztoku v caput humeri lt.dx. na axiálním CT]]

Contraindications

osteogenesis imperfecta
osteopetrosis
fractura tibiae or other bones chosen for puncture
patient refusal
injection site infection, previous orthopedic surgery
intra-abdominal and pelvic injuries from intended bony entry in the inferior vena cava basin

approches

hlavice humeru (vhodné při resuscitaci)
proximální část tibie v místě tuberositas tibiae (děti < 6 let)
distální femur
patní kost (novorozenci a děti < 6 měsíců)

proximal tibial procedure

pacient je v poloze na zádech
mírně pokrčenou dolní končetinu podložíme tak, aby se bérec opíral o pevný podklad (tj. aby byla zajištěna dobrá stabilizace bérce)
místem vpichu je proximální část tibie, přibližně 2 cm mediálně a 2 cm proximálně (distal in children) od tuberositas tibiae, při výkonu musí být zabezpečeny přísné aseptic conditions must be ensured during the procedure
kolmo na dlouhou osu bonei penetrujeme kostní matrix a šroubovitým pohybem vnikáme do we penetrate the bone matrix and penetrate the bone marrow (vniknutí do ní je spojeno se ztrátou odporu), hloubka vpichu je obvykle 1–1,5 cm

After introducing

jehla je ve správné poloze, když pevně stojí v kosti a když při aspiraci nasáváme dřeň
u pacienta při vědomí aplikujeme velmi pomalu 2 ml lokálního anestetika
pokud si myslíme, že jsme ve správné poloze, ale kostní dřeň nelze nasát, propláchneme jehlu 10 ml (děti 2 – 5 ml) fyziologického roztoku a sledujeme, zda nevzniká vyklenutí
první bolus razantně během 5 s k rozvolnění trámčiny kosti (No flush = no flow)
pokud je vše bez problémů, jehlu fixujeme a sterilně kryjeme

Complications

povrchové infekce
osteomyelitis
subperiostální infúze
compartment syndrome
přechodné objevení blastů v periferní krvi
dislokace jehly a následné krvácení
podle některých autorů u dospělých pacientů tuková embolie
poškození růstové chrupavky u dětí

Video

<mediaplayer width='500' height='300'>https://www.youtube.com/watch?v=KHXSfh2ZRDM</mediaplayer>

Revision as of 13:57, 18 November 2022 (edit) 88.100.155.157 (talk) No edit summary Tag: Visual edit ← Older edit		Revision as of 13:59, 18 November 2022 (edit) (undo) Shilmanadi (talk \| contribs) No edit summary Newer edit →
Line 1:		Line 1:
	'''Intraosseous infusion''' in cases where it is necessary to ensure access to [[~~krev~~]]n which cannot be ensured [[~~kanylace periferní žíly\|i. v. linkou~~]]. All drugs, including solutions and blood derivatives, can be administered intraosseously. The speed of onset of action is comparable to [[~~kanylace centrální žíly\|centrálním žilním přístupem~~]]. It is most often used in pre-hospital care, in hospitals it can help in urgent situations, especially if it is not possible to cannulate the central vein reliably and quickly.		'''Intraosseous infusion''' in cases where it is necessary to ensure access to [[the bloodstream]]n which cannot be ensured [[even with a line]]. All drugs, including solutions and blood derivatives, can be administered intraosseously. The speed of onset of action is comparable to [[central venous access]]. It is most often used in pre-hospital care, in hospitals it can help in urgent situations, especially if it is not possible to cannulate the central vein reliably and quickly.

	A certain disadvantage is the '''painful application''', the need for special cannulae and '''the limited time''' of possible use - 6-12, exceptionally a maximum of 24 hours of use are mentioned. The pain during bone penetration is overestimated, it is comparable or less than skin puncture with a wider cannula (Gronych 2014).		A certain disadvantage is the '''painful application''', the need for special cannulae and '''the limited time''' of possible use - 6-12, exceptionally a maximum of 24 hours of use are mentioned. The pain during bone penetration is overestimated, it is comparable or less than skin puncture with a wider cannula (Gronych 2014).

Intraosseous infusion: Difference between revisions

Revision as of 13:59, 18 November 2022

Contents