Characteristics of Children Who Undergo Intraosseous Needle Placement

Abstract

Intraosseous (IO) access is a standard of care for pediatric emergencies in the absence of conventional intravenous access. Intraosseous needles provide access for resuscitation fluids and medications and are often placed in the emergency department. However, there are no studies to date that describe the characteristics of pediatric IO needle recipients or their dispositions and outcomes. This study examined the characteristics and disposition of children following IO needle placement by prehospital and emergency room teams before being transported to a children's hospital. We conducted a retrospective descriptive analysis of pediatric patients who had an IO needle placed as a part of their transport care. Data was extracted from a Level 1 trauma tertiary care children's hospital transport database from 1993 to 2009. We measured diagnosis, insertion reason, insertion time (day vs. night shift), complications, and disposition of patients after IO needle placement. There were 143 eligible patients in the study; 65% were males. Mean patient's age was 1.2 years (range: 0.01-13 years). Intraosseous needles were placed most often for patients with cardiopulmonary compromise. Of the 143 patients transported, 53% (n = 76) were placed for no intravenous access and 34% (n = 49) were placed for nonperfusing rhythm. The majority of the IO needles were placed during the daytime (0700-1900 hr), and most patients experienced no complications (n = 67; 47%). However, of those who experienced a complication, 27% were due to infiltration of the IO needle. Of those admitted to hospital, 58% (n = 83) were ultimately discharged home. Intraosseous access provides a safe and reliable method for rapidly achieving a route for administration of medications, fluids and blood products. It is a lifesaving measure with most IO needles successfully placed by referring facilities prior to transport, with few reported complications.

Current utilization of interosseous access in pediatrics: a population-based analysis using an EHR database, TriNetX

“…We identified possible complications 1 day to 3 months after IO use in this population, including lower extremity thrombosis, fracture, cellulitis/abscess, pulmonary embolism, and osteomyelitis. Our study demonstrates similar complication rates as previously reported [ 17 , 18 , 23 , 28 ]. In this data set, the low incidence of complications reported may be explained by the mortality rate.…”

“…The IO route allows access to the systemic venous circulation via the placement of a hollow needle through the cortex of the bone into the medullary cavity, usually through the proximal tibia or distal femur. A network of intramedullary venous sinusoids drains directly into the central venous system, allowing blood sampling and the ability to administer any traditionally intravenous fluids or medications [7,17,18]. Because it allows quick and safe access, the most recent American Heart Association's Pediatric Advanced Life Support (AHA PALS) update recommends that IO cannulation be the vascular access method of choice when intravenous access has not been established within 30 s of resuscitative care [11,19].…”

Current Utilization of Interosseous Access in Pediatrics: A Population-Based Analysis using an EHR database, TriNetX

“…Our study demonstrates similar complication rates as previously reported. 16,17,22,27 In this data set, the low incidence of complications reported may be explained by the mortality rate. It is likely that more complications occurred with patients who did not survive and thus were not reported within the EHR.…”

Integration of Intraosseous Approach Method in Georgia

“…The IO route can be successfully secured in most cases with a significant shorter time compared with vascular access insertion, shorter length of stay, and decrease in mortality in IO group versus intravenous (IV) group. [1][2][3][4][5] In pediatric emergencies, as in case of shock, the use of IO route is recommended to get rapid vascular access as soon as possible, as it revealed better outcome. 6 In management of pediatric emergencies, peripheral IV access is preferred, but sometimes, establishing peripheral venous access is impossible, or it may take too much time because of anatomical or physiological characteristics, such as an excessive subcutaneous fatty tissue and veins with a small diameter, or in addition, during life-threatening conditions such as cardiopulmonary arrest, septic or hypovolemic shock, or prolonged status epilepticus, these features alone or in combination can make venous catheterization impossible.…”

“…Moreover, IO insertion is performed in less than 2 minutes if it is done by skilled professional and the equipment is of high quality. 2,[8][9][10][11][12] Therefore, the IO access is seen as the alternative way for fluid and drug administration in complicated cases or when peripheral venous catheterization is impossible. 7 Nevertheless, in different countries, in numerous services, the IO approach is not used at all and/or is limited due to lack of demand and lack of training on the issue of medical staff.…”