| Infusiones intraóseas: Una revisión para el anestesiólogo enfocada al uso pediátrico |
Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use.
Tobias JD, Ross AK.
Departments of Anesthesiology, University of Missouri, Columbia, Missouri 65212, USA. tobiasj@health.missouri.ed
Anesth Analg. 2010 Feb 1;110(2):391-401. Epub 2009 Nov 6.
Abstract
Intraosseous (IO) access is used most frequently for emergency care of critically ill infants and children when IV access cannot be rapidly achieved. Despite its efficacy in such situations, applications outside of the emergency room or resuscitation scenario have been limited. Furthermore, although the technique is emphasized in the teaching of those caring for critically ill infants and children in the emergency room or critical care setting, there is limited emphasis on its potential use in the perioperative setting. When peripheral venous access cannot be achieved in the operating room, alternative means of securing vascular access such as central line placement or surgical cutdown are generally successful; however, these techniques may be time consuming. Anyone providing anesthesia care for infants and children may want to become facile with the use of IO infusions for selected indications. We present the history of IO infusions, review the anatomy of the bone marrow space, discuss the potential role of IO infusions in the perioperative period, and analyze its adverse effect profile
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| Acceso intraóseo de urgencia en un helicóptero de servicio médico: estudio retrospectivo |
Emergency intraosseous access in a helicopter emergency medical service: a retrospective study.
Sunde GA, Heradstveit BE, Vikenes BH, Heltne JK.
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. gasu@helse-bergen.no
Scand J Trauma Resusc Emerg Med. 2010 Oct 7;18:52.
Abstract
BACKGROUND: Intraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS. METHODS: We reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G® - Waismed), manual bone marrow aspiration needle (Inter V - Medical Device Technologies) and EZ-IO® (Vidacare), used on both adults and paediatric patients. RESULTS: During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success on first attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p < 0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%) and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used in connection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Other diagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratory failure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger than two years. No cases of osteomyelitis or other serious complications were documented on the follow-up. CONCLUSIONS: Newer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.
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| Estudio observacional, prospectivo para determinar la facilidad de accesos vasculares en el adulto utilizando un nuevo dispositivo intraóseo. |
An observational, prospective study to determine the ease of vascular access in adults using a novel intraosseous access device.
Ong ME, Ngo AS, Wijaya R.
Department of Emergency Medicine, Singapore General Hospital, Singapore. marcus.ong.e.h@sgh.com.sg
Ann Acad Med Singapore. 2009 Feb;38(2):121-4.
Abstract
INTRODUCTION: Intraosseous access is an alternative to conventional intravenous access when access is difficult or impossible in the adult population. The EZ-IO is a novel intraosseous access device designed for use in adults, utilising a powered driver. MATERIALS AND METHODS: A prospective, observational study involving a convenience sample of 25 medical students, physicians and nursing staff recruited as study subjects to secure intraosseous access using the EZIO powered drill device, on a bone model. RESULTS: Twenty-three (92%) of the 25 study subjects required only 1 attempt at placing the EZ-IO. There were 24 (96%) successful placements of the EZ-IO. The average time taken to place the EZ-IO was 13.9 seconds. Twenty (87%) of 23 participants reported easier placement with the EZ-IO than an intravenous cannula. The average time taken for the physicians, nursing staff and medical students was 3.71 (+/- SD 1.70) seconds, 7.88 (+/- SD 4.02) seconds and 33.7 (24.5), respectively. Overall mean difficulty of insertion score (VAS) was 3.1 (+/- SD 1.9). CONCLUSION: The intraosseous access device evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department.
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| La infusión intraósea ocasional |
The occasional intraosseous infusion.
Bosomworth NJ.
john.bosomworth@interiorhealth.ca
Can J Rural Med. 2008 Spring;13(2):80-3.
Introduction
Long bones in infants are filled with marrow that contains vascularized sinusoids. These sinusoids eventually drain into the systemic venous circulation. The marrow cavity acts as a rigid vein and so will not collapse, even in the face of severe volume loss. No matter how dehydrated or volume-depleted the child is, there is always a rigid tube that can be punctured to replace the required fluids.
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