Intraosseous infusion in infants. Case report of a complication.

Burke, Teresa; Kehl, Douglas K.

doi:10.2106/00004623-199303000-00015

Cited by 25 publications

(6 citation statements)

References 4 publications

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“…An alternative to gaining vascular access is the welldocumented route of intraosseous infusion (Burke and Kehl, 1993;Ribeiro et al, 1993;Ellemunter et al, 1999;Calkins et al, 2000). The anteromedial surface of the tibia is the most commonly used site for placement of intraosseous infusions.…”

Section: Introductionmentioning

confidence: 99%

“…The intravenous line is then attached to the needle and secured on the medial aspect of the tibia. Especially in children, this technique is most efficient because of the presence of a highly vascular marrow and large venous sinusoids in their long bones (Burke and Kehl, 1993). Infused fluid is absorbed within the cancellous bone through the nutrient and emissary veins, which drain into the systemic circulation (Ribeiro et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

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Finding an ideal site for intraosseous infusion of the tibia: An anatomical study

2002

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Intraosseous infusion is a technique used for the administration of fluids to a hemodynamically shocked child in whom attempts to access the vascular system have been unsuccessful. Although few complications are seen, injury to the epiphyseal growth plate during the performance of this technique remains a serious problem. This study investigates the relationship between the site of insertion of the intraosseous needle and the epiphyseal growth plate, and the ease of needle insertion into various locations of the tibia in newborn infants. Fourteen newborn infant cadavers (28 tibias in total) were dissected after placement of four needles: 1). through the tibial tuberosity (Site A); 2). 10 mm distal to the tibial tuberosity (Site B); 3). 20 mm distal to the tibial tuberosity (Site C) and; 4). 10 mm proximal to the tibial tuberosity (Site D). Distances from the distal end of the epiphyseal growth plate were measured. A high number of needle placements at Site A were inserted into the epiphyseal growth plate. Most placements at Site B were between 10 and 16 mm from the epiphyseal growth plate on the right side and between 10 and 15 mm on the left side, and all were inserted without difficulty. Although far from the epiphyseal growth plate, most placements at Site C were very difficult to insert because of the thick cortical bone. All placements at Site D entered the epiphysis or the epiphysis and joint space of the knee. An insertion site of at least 10 mm distal to the tibial tuberosity is therefore recommended to avoid epiphyseal growth plate injury and ensure ease of insertion.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Finding an ideal site for intraosseous infusion of the tibia: An anatomical study

2002

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“…Our study results show that the most common cause of IO failure was no flow or low flow. Other studies have reported other types of IO complications, including extravasation which can lead to compartment syndrome 19,20 and osteomyelitis, 5 which was reported as 0.6% in a review. 21 Most other complications were case reports.…”

Section: Discussionmentioning

confidence: 95%

Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest

et al. 2021

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Objective: Obtaining vascular access during out-of-hospital cardiac arrest (OHCA) is challenging. The aim of this study was to determine if using intraosseous (IO) access when intravenous (IV) access fails improves outcomes. Methods: This was a prospective, parallel-group, cluster-randomised study that compared 'IV only' against 'IV + IO' in OHCA patients, where if 2 IV attempts failed or took more than 90 s, paramedics had 2 further attempts of IO. Primary outcome was any return of spontaneous circulation (ROSC). Secondary outcomes were insertion success rate, adrenaline administration, time to adrenaline and survival outcome. Results: A total of 1007 patients were included in the analysis. An Intention To Treat analysis showed a significant difference in success rates of obtaining vascular access in the IV + IO arm compared to the IV arm (76.6% vs 61.1% p = 0.001). There were significantly more patients in the IV + IO arm than the IV arm being administered prehospital adrenaline (71.3% vs 55.4% p = 0.001). The IV + IO arm also received adrenaline faster compared to the IV arm in terms of median time from emergency call to adrenaline (23 min vs 25 min p = 0.001). There was no significant difference in ROSC (adjusted OR 0.99 95%CI: 0.75À1.29), survival to discharge or survival with CPC 2 or better in both groups. A Per Protocol analysis also showed there was higher success in obtaining vascular access in the IV + IO arm, but ROSC and survival outcomes were not statistically different. Conclusion: Using IO when IV failed led to a higher rate of vascular access, prehospital adrenaline administration and faster adrenaline administration. However, it was not associated with higher ROSC, survival to discharge, or good neurological outcome.

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“…There are case reports of IO lines being used for neonates in the neonatal intensive care unit (NICU), 2– 6 and in the emergency department 7 . Intraosseous access in the neonate appears to be safe, and reported complications are limited to rare cases of compartment syndrome from infiltrated lines 8 . However, most published reports describe older neonates who have had other previous forms of vascular access.…”

mentioning

confidence: 99%

“…7 Intraosseous access in the neonate appears to be safe, and reported complications are limited to rare cases of compartment syndrome from infiltrated lines. 8 However, most published reports describe older neonates who have had other previous forms of vascular access. The use of IO as a first-or second-line choice for access in the first 24 hours of life is more controversial.…”

mentioning

confidence: 99%

Intraosseous Access for Neonatal and Newborn Resuscitation in the National Park Service (NPS)

Schmitt

Stroh²,

Shalit³

et al. 2011

Prehosp. Disaster med.

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Intraosseous infusion in infants. Case report of a complication.

Cited by 25 publications

References 4 publications

Finding an ideal site for intraosseous infusion of the tibia: An anatomical study

Finding an ideal site for intraosseous infusion of the tibia: An anatomical study

Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest

Intraosseous Access for Neonatal and Newborn Resuscitation in the National Park Service (NPS)

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