Use of intra-osseous access in adults: a systematic review

Abstract

BackgroundIndications for intra-osseous (IO) infusion are increasing in adults requiring administration of fluids and medications during initial resuscitation. However, this route is rarely used nowadays due to a lack of knowlegde and training. We reviewed the current evidence for its use in adults requiring resuscitative procedures, the contraindications of the technique, and modalities for catheter implementation and skill acquisition.MethodsA PubMed search for all articles published up to December 2015 was performed by using the terms “Intra-osseous” AND “Adult”. Additional articles were included by using the “related citations” feature of PubMed or checking references of selected articles. Editorials, comments and case reports were excluded. Abstracts of all the articles that the search yielded were independently screened for eligibility by two authors and included in the analysis after mutual consensus. In total, 84 full-text articles were reviewed and 49 of these were useful for answering the following question “when, how, and for which population should an IO infusion be used in adults” were selected to prepare independent drafts. Once this step had been completed, all authors met, reviewed the drafts together, resolved disagreements by consensus with all the authors, and decided on the final version.ResultsIO infusion should be implemented in all critical situations when peripheral venous access is not easily obtainable. Contraindications are few and complications are uncommon, most of the time bound to prolonged use. The IO infusion allows for blood sampling and administration of virtually all types of fluids and medications including vasopressors, with a bioavailability close to the intravenous route. Unfortunately, IO infusion remains underused in adults even though learning the technique is rapid and easy.ConclusionsIndications for IO infusion use in adults requiring urgent parenteral access and having difficult intravenous access are increasing. Physicians working in emergency departments or intensive care units should learn the procedures for catheter insertion and maintenance, the contraindications of the technique, and the possibilities this access offers.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1277-6) contains supplementary material, which is available to authorized users.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…This may require additional vascular access ports. Intraosseous access, which can be quickly and reliably established (even in adults), can be used to rapidly administer the initial doses of any antimicrobial [90,91]. In addition, intramuscular preparations are approved and available for several first-line β-lactams, including imipenem/ cilastatin, cefepime, ceftriaxone, and ertapenem.…”

Cesarean delivery under local anesthesia: A literature review

“…Intraosseous access quickly allows for rapid fluid resuscitation and medication delivery through direct injection into the bone marrow. 13,14 Intraosseous access provides a more stable, non-collapsible entry point into the venous system; however, precaution should be taken to evaluate the injection site to prevent fluid accumulation in the leg cavity, resulting in compartment syndrome. 13,14 In addition, intraosseous access allows for ease of pain management techniques when regional or general anesthesia cannot be initiated; particularly in this presentation for infiltration anesthesia cesarean delivery.…”

Applied anatomy for tibial intraosseous access in adults

“…The distal tibia, distal femur, superior iliac crest, and sternum can also be used. In cases of pelvic or thoracic trauma, the calcaneus and styloid projections of the radius are suggested sites for infusion (Petitpas et al, ). IOI is particularly recommended in infants because of its simple technique and higher success rate.…”