Procedures for Vascular Access

Wald, Samuel H.; Mendoza, J.; Mihm, Frederick G.; Coté, Charles J.

doi:10.1016/b978-0-323-42974-0.00049-5

Cited by 1 publication

(2 citation statements)

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“…To prevent damage to the epiphyseal plate, the tip of the needle should be pointing towards the feet. The ideal location to puncture the proximal tibia ranges between 10 mm to 30 mm [4,12] inferior to the tibial tuberosity, while Ellemunter et al(1999) punctured the proximal tibia between 5mm and 10mm and did not observe any adverse side effects [7]. Table 6 illustrates the ratios between the mean distances between the different measurements.…”

Section: Table 5: Mean Statistic Of the Measurements At 10 MM Interva...mentioning

confidence: 99%

“…Boon et al(2003) found it difficult inserting a needle 20 mm inferior to the tibial tuberosity as the cortical bone thickness was too thick [3]. Wald et al(2019) recommend that the needle be inserted 10 to 20 mm inferior to the tibial tuberosity on the medial surface [12]. Ellemunter et al (1999) was placed in the medial plane 5 mm to 10 mm inferior to the tibial tuberosity in a total of 27 neonatal patients.…”

Section: Introductionmentioning

confidence: 99%

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Proximal tibial dimensions in a formalin-fixed neonatal cadaver sample: an intraosseous infusion approach

2021

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Purpose: Methods to administer intramedullary medication and fluid infusion in both adults and children date to the early 20 th century. Studies have shown that intraosseous access in the proximal tibia is ideal for resuscitation efforts as fewer critical structures are at risk, and neither is the blood flow to the lower limbs compromised. Insertion of a needle in children younger than 5 years does have the risk to damage to the epiphyseal growth plate. Therefore, the aim of this study was to determine the ideal intraosseous insertion site distal to the epiphyseal growth plate in neonates. Methods:The samples consisted of both the left and right sides of 15 formalin-fixed neonatal cadavers. The dimensions were measured on the superior surfaces of each section, anteromedial border, cortical thickness, medullary space. Results:The most desirable location to gain vascular access is at 10 mm inferior to the tibial tuberosity. Conclusion:The smallest cortical thickness (1.32 mm), the largest medullary space (4.50 mm) and the largest anteromedial surface (7.72 mm) was seen at 10mm inferior to the tibial tuberosity. It is imperative that health care professionals are familiar with the osteological sites that could be safely used for an intraosseous infusion procedure.

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Section: Table 5: Mean Statistic Of the Measurements At 10 MM Interva...mentioning

confidence: 99%