Intraosseous infusion: Difference between revisions
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*[[shock]] of any etiology | *[[shock]] of any etiology | ||
*[[status epilepticus]] | *[[status epilepticus]] | ||
[[File:Intraosseous Infusion.PNG|thumb|Intraosseous Infusion]] | |||
===Contraindications=== | ===Contraindications=== | ||
*[[osteogenesis imperfecta]] | *[[osteogenesis imperfecta]] | ||
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*intra-abdominal and pelvic injuries from intended bony entry in the inferior vena cava basin | *intra-abdominal and pelvic injuries from intended bony entry in the inferior vena cava basin | ||
===approches=== | ===approches=== | ||
* | ** humeral head (suitable for resuscitation) | ||
* | ** proximal part of the tibia at the site of ''tuberositas tibiae'' (children < 6 years) | ||
* | ** distal femur | ||
* | ** calcaneus (newborns and children < 6 months) | ||
===proximal tibial procedure=== | ===proximal tibial procedure=== | ||
* | ** the patient is in the supine position | ||
* | ** We support the slightly bent lower limb so that the lower leg rests on a firm base (i.e. to ensure good stabilization of the lower leg) | ||
* | *the injection site is the proximal part of the tibia, approximately 2 cm medial and 2 cm proximal ('''distal in children''') from the ''tuberositas tibiae'' , strict [[aseptic conditions must be ensured during the procedure]] | ||
*kolmo na dlouhou osu [[bone]]i 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 | *kolmo na dlouhou osu [[bone]]i 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=== | ===After introducing=== | ||
Revision as of 14:02, 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
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
- humeral head (suitable for resuscitation)
- proximal part of the tibia at the site of tuberositas tibiae (children < 6 years)
- distal femur
- calcaneus (newborns and children < 6 months)
proximal tibial procedure
- the patient is in the supine position
- We support the slightly bent lower limb so that the lower leg rests on a firm base (i.e. to ensure good stabilization of the lower leg)
- the injection site is the proximal part of the tibia, approximately 2 cm medial and 2 cm proximal (distal in children) from the tuberositas tibiae , strict 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>
links
references
- HAVRÁNEK, Jiří: Intraoseální infuze. (upraveno)
- Gronych, Luděk 2014
- Leták výrobce pro lokalizaci návrtu na humeru
- Kubalová, Jana 2017
Související články
Kategorie:Pediatrie Kategorie:Anesteziologie Kategorie:Neodkladná medicína
