Intraosseous infusion: Difference between revisions
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''' | '''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). | |||
=== | ===Indication=== | ||
* | *impossibility of inserting an intravenous cannula (two unsuccessful attempts in an emergency situation) | ||
*[[ | *[[cardiopulmonary resuscitation]] | ||
*[[ | *[[shock]] of any etiology | ||
*[[ | *[[status epilepticus]] | ||
[[File:Intraosseous Infusion.PNG|thumb|Intraosseous Infusion]] | |||
=== | ===Contraindications=== | ||
*[[osteogenesis imperfecta]] | *[[osteogenesis imperfecta]] | ||
*[[osteopetrosis]] | *[[osteopetrosis]] | ||
*[[fractura tibiae]] | *[[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]] | ||
* | *perpendicular to the long axis of the [[bone, we penetrate the bone matrix and penetrate the bone marrow]] with a helical movement (penetration into it is associated with a loss of resistance), the depth of injection is usually 1-1.5 cm | ||
=== | ===After introducing=== | ||
* | |||
* | * the needle is in the correct position when it rests firmly in the bone and when we aspirate the marrow | ||
* | * in a conscious patient, we very slowly apply 2 ml of local anesthetic | ||
* | *if we think we are in the right position, but the bone marrow cannot be aspirated, we flush the needle with 10 ml (children 2-5 ml) [[of physiological solution]] and observe whether there is an arching | ||
* | * first bolus forcefully within 5 sec loosening of trabecular bone (No flush = no flow) | ||
=== | * if everything is without problems, fix the needle and cover it sterilely | ||
* | ===Complications=== | ||
* superficial infections | |||
*[[osteomyelitis]] | *[[osteomyelitis]] | ||
* | * subperiosteal infusion | ||
*[[compartment | *[[compartment syndrome]] | ||
* | * transient appearance of blasts in peripheral blood | ||
* | * needle dislocation and subsequent bleeding | ||
* | * according to some authors, fat embolism in adult patients | ||
* | * damage to growth cartilage in children | ||
===Video=== | ===Video=== | ||
<mediaplayer width='500' height='300'>https://www.youtube.com/watch?v=KHXSfh2ZRDM</mediaplayer><noinclude> | <mediaplayer width='500' height='300'>https://www.youtube.com/watch?v=KHXSfh2ZRDM</mediaplayer><noinclude> | ||
== | ==Links== | ||
=== | ===References=== | ||
*{{ | *{{Cite | ||
| | | surname1 = Ševčík | ||
| | | name1 = Pavel | ||
| | | others = yes | ||
| | | type = book | ||
| | | title = Intenzivní medicína | ||
| | | edition = 3 | ||
| | | publisher = Galén | ||
| | | year = 2014 | ||
| isbn = 9788074920660 | | isbn = 9788074920660 | ||
| | | range = 1195 | ||
| | | pages = 100 | ||
}} | }} | ||
*HAVRÁNEK, Jiří: ''Intraoseální infuze''. (upraveno) | *HAVRÁNEK, Jiří: ''Intraoseální infuze''. (upraveno) | ||
| Line 62: | Line 63: | ||
*[https://p.widencdn.net/x101n7/MC-000620Rev2_Arrow_EZIO_EMS_ProximalHumerus_DataSheet_HR_SAM Leták výrobce pro lokalizaci návrtu na humeru] | *[https://p.widencdn.net/x101n7/MC-000620Rev2_Arrow_EZIO_EMS_ProximalHumerus_DataSheet_HR_SAM Leták výrobce pro lokalizaci návrtu na humeru] | ||
*[https://docplayer.cz/100222220-Kdyz-nejde-zajistit-zilu-up-to-date-2017.html Kubalová, Jana 2017] | *[https://docplayer.cz/100222220-Kdyz-nejde-zajistit-zilu-up-to-date-2017.html Kubalová, Jana 2017] | ||
=== | ===Related articles=== | ||
*[[ | *[[Infusion]] | ||
*[[ | *[[Cardiopulmonary resuscitation of the newborn]] | ||
</noinclude>[[ | </noinclude> | ||
[[category:Paediatrics]] [[category:Anesthesiology]] [[category:emergency medicine]] | |||
Latest revision as of 13:17, 19 November 2023
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[edit | edit source]
- impossibility of inserting an intravenous cannula (two unsuccessful attempts in an emergency situation)
- cardiopulmonary resuscitation
- shock of any etiology
- status epilepticus
Contraindications[edit | edit source]
- 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[edit | edit source]
- 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[edit | edit source]
- 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
- perpendicular to the long axis of the bone, we penetrate the bone matrix and penetrate the bone marrow with a helical movement (penetration into it is associated with a loss of resistance), the depth of injection is usually 1-1.5 cm
After introducing[edit | edit source]
- the needle is in the correct position when it rests firmly in the bone and when we aspirate the marrow
- in a conscious patient, we very slowly apply 2 ml of local anesthetic
- if we think we are in the right position, but the bone marrow cannot be aspirated, we flush the needle with 10 ml (children 2-5 ml) of physiological solution and observe whether there is an arching
- first bolus forcefully within 5 sec loosening of trabecular bone (No flush = no flow)
- if everything is without problems, fix the needle and cover it sterilely
Complications[edit | edit source]
- superficial infections
- osteomyelitis
- subperiosteal infusion
- compartment syndrome
- transient appearance of blasts in peripheral blood
- needle dislocation and subsequent bleeding
- according to some authors, fat embolism in adult patients
- damage to growth cartilage in children
Video[edit | edit source]
<mediaplayer width='500' height='300'>https://www.youtube.com/watch?v=KHXSfh2ZRDM</mediaplayer>
Links[edit | edit source]
References[edit | edit source]
- ŠEVČÍK, Pavel, et al. Intenzivní medicína. 3. edition. Galén, 2014. 1195 pp. pp. 100. ISBN 9788074920660.
- HAVRÁNEK, Jiří: Intraoseální infuze. (upraveno)
- Gronych, Luděk 2014
- Leták výrobce pro lokalizaci návrtu na humeru
- Kubalová, Jana 2017
