The versatility of intraosseous vascular access in perioperative medicine: a case series

Anson, Jonathan; Sinz, Elizabeth H.; Swick, John T.

doi:10.1016/j.jclinane.2014.10.002

Cited by 12 publications

(11 citation statements)

References 27 publications

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“…Tal eficácia se dá porque os vasos intramedulares e os lagos venosos estão envoltos por paredes ósseas firmes e que não são colabáveis, mantendo-se pérveas, mesmo nos casos de parada cardíaca e choques 7 . A utilidade seu uso tem sido comprovado em emergência de adultos, pediatria, e situações militares 3,7,8 , bem como em não-emergências, quando o acesso vascular não pode ser obtido, ou quando o paciente pode estar em risco de aumento da morbidade ou mortalidade, além de ocasiões como no período perioperatório (9). A técnica costuma ser de fácil execução e bem sucedida em 90-95% dos casos em que é indicada 10,11 .…”

Section: é Recomendado Pela Americanunclassified

Limitação Da Utilização Do Acesso Intraósseo: Aspectos Da Enfermagem E Da Instituição De Saúde

Schumaher

Jara

Bóbbo

et al. 2018

revenf

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Objetivo: Verificar a realização do acesso intraósseo por enfermeiros. Método: Estudo analítico transversal, realizado por meio da aplicação de um questionário. Resultados: Demonstrou-se que 97,0% dos profissionais nunca realizaram o acesso (p<0,001), e 48,5% tiveram um treinamento adequado. Apenas 9,1% relatou se sentir seguro para executar a técnica (p<0,001) e 69,7% responderam que não possuem apoio técnico, e não possuem material apropriado. Conclusão: Demonstrou-se que existe uma limitação do uso do acesso intraósseo. A falta de autonomia para realizar a técnica pode se explicar pela falta de habilidade prática e conhecimento teórico dos enfermeiros, e pela falta de protocolos e acesso à informações institucionais, treinamentos e insumos.Descritores: Infusões Intraósseas; Enfermagem; Desenvolvimento de pessoal. LIMITATION OF THE USE OF INTRAÓSSEO ACCESS: ASPECTS OF NURSING AND HEALTH INSTITUTIONAim: To verify the achievement of intraosseous access by nurses. Method: Cross-sectional analytical study, carried out through the application of a questionnaire. Results: It was demonstrated that 97,0% of the professionals never performed access (p <0.001), and 48,5% had adequate training. Only 9,1% reported feeling safe to perform the technique (p <0.001) and 69,7% answered that they do not have technical support, and do not have appropriate material. Conclusion: It has been demonstrated that there is a limitation of the use of intraosseous access. The lack of autonomy to perform the technique can be explained by the lack of practical skills and theoretical knowledge of nurses, and the lack of protocols and access to institutional information, training and inputs. Descriptors: Intraosseous infusions; Nursing; Development of personnel. ACCESO LIMITACIÓN DE USO INTRAÓSEA: ASPECTOS DE LA ENFERMERÍA Y INSTITUCIÓN DE SALUD.Objetivo: Verificar la realización del acceso intraóseo para las enfermeras. Método: Estudio transversal analítico realizado mediante la aplicación de un cuestionario. Resultados: Se demostró que 97,0% de los encuestados nunca hizo de acceso (p <0,001), y 48,5% tenía una formación adecuada. Sólo 9.1% reportó sentirse seguro para llevar a cabo la técnica (p <0,001) y 69,7% dijeron que no tienen soporte, y no tienen ningún material adecuado. Conclusión: Se ha demostrado que existe una limitación del uso de la vía intraósea. La falta de autonomía para llevar a cabo la técnica puede explicarse por la falta de habilidades prácticas y conocimientos teóricos de las enfermeras, y la falta de protocolos y el acceso a la información institucional, la capacitación y los insumos. Descriptores: Infusiones intraóseas; enfermería; desarrollo del personal. Enferm. Foco 2018; 9 (2): 44-50

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Section: é Recomendado Pela Americanunclassified

Limitação Da Utilização Do Acesso Intraósseo: Aspectos Da Enfermagem E Da Instituição De Saúde

Schumaher

Jara

Bóbbo

et al. 2018

revenf

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“…In cases of trauma, hemorrhage and cardiac arrest, establishing rapid vascular access is essential for return of spontaneous circulation (ROSC) 5 6. Injuries that cause hemorrhage lead to volume depletion and vascular collapse.…”

Section: Introductionmentioning

confidence: 99%

Effects of humeral intraosseous epinephrine in a pediatric hypovolemic cardiac arrest porcine model

Neill¹,

Burgert

Blouin

et al. 2020

Trauma Surg Acute Care Open

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BackgroundAims of the study were to determine the effects of humerus intraosseous (HIO) versus intravenous (IV) administration of epinephrine in a hypovolemic, pediatric pig model. We compared concentration maximum (Cmax), time to maximum concentration (Tmax), mean concentration (MC) over time and return of spontaneous circulation (ROSC).MethodsPediatric pig were randomly assigned to each group (HIO (n=7); IV (n=7); cardiopulmonary resuscitation (CPR)+defibrillation (defib) (n=7) and CPR-only group (n=5)). The pig were anesthetized; 35% of the blood volume was exsanguinated. pigs were in arrest for 2 min, and then CPR was performed for 2 min. Epinephrine 0.01 mg/kg was administered 4 min postarrest by either route. Samples were collected over 5 min. After sample collection, epinephrine was administered every 4 min or until ROSC. The Cmax and MC were analyzed using high-performance liquid chromatography. Defibrillation began at 3 min postarrest and administered every 2 min or until ROSC or endpoint at 20 min after initiation of CPR.ResultsAnalysis indicated that the Cmax was significantly higher in the IV versus HIO group (p=0.001). Tmax was shorter in the IV group but was not significantly different (p=0.789). The MC was significantly greater in the IV versus HIO groups at 90 and 120 s (p<0.05). The IV versus HIO had a significantly higher MC (p=0.001). χ2 indicated the IV group (5 out of 7) had significantly higher rate of ROSC than the HIO group (1 out of 7) (p=0.031). One subject in the CPR+defib and no subjects in the CPR-only groups achieved ROSC.DiscussionBased on the results of our study, the IV route is more effective than the HIO route.

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“…Intraosseous (IO) access is used as an alternative vascular access for patients in emergency situations if difficulties are encountered with peripheral venous access. IO access has an established role in administering fluids and medications to patients in pre‐hospital and in‐hospital critical care . A small amount of bone marrow is usually drawn from the IO space to confirm the correct placement of the needle.…”

Section: Introductionmentioning

confidence: 99%

Point‐of‐care analyses of blood samples from intraosseous access in pre‐hospital critical care

Jousi

Björkman

Nurmi

2019

Acta Anaesthesiol Scand

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Background Intraosseous (IO) access is used for fluid and medication administration in emergency situations when difficulties with vascular access are encountered. IO access would be readily available to take samples for point‐of‐care (POC) analysis, but there is scarce evidence about the reliability of POC analysis of IO samples among emergency patients. The aim of this study was to evaluate the feasibility and reliability of POC analysis of IO samples in critically ill pre‐hospital patients. Methods We performed a prospective, observational study in 35 critically ill pre‐hospital patients. After inserting a humeral IO needle, we immediately drew an IO sample. We compared the results to an arterial sample drawn from the same patient within 5 (blood gases) or 15 (other parameters) minutes. Samples were analysed with an i‐STAT® POC analyser for blood gases, acid‐base balance, electrolytes, glucose and haemoglobin. The agreement between each patient’s IO and arterial samples was analysed using the Bland‐Altman method. The results were compared to responses about acceptable bias on a questionnaire sent to 16 experienced emergency physicians. Results The analysis was successful for 23 patients (70%). Higher age was associated with failed analyses. The average bias was acceptable for base excess, pH, standard bicarbonate, glucose, ionized calcium and sodium. IO potassium values were systematically higher than arterial values. IO haemoglobin values had widely varying agreement. Conclusion When vascular access is challenging, IO access can be used for emergency POC analyses to help guide clinical decision‐making. However, the limitations of IO POC analyses must be carefully considered.

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The versatility of intraosseous vascular access in perioperative medicine: a case series

Cited by 12 publications

References 27 publications

Limitação Da Utilização Do Acesso Intraósseo: Aspectos Da Enfermagem E Da Instituição De Saúde

Limitação Da Utilização Do Acesso Intraósseo: Aspectos Da Enfermagem E Da Instituição De Saúde

Effects of humeral intraosseous epinephrine in a pediatric hypovolemic cardiac arrest porcine model

Point‐of‐care analyses of blood samples from intraosseous access in pre‐hospital critical care

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