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Bouhamdan J, Polsinelli G, Akers KG, Paxton JH. A Systematic Review of Complications from Pediatric Intraosseous Cannulation. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Compartment Syndrome of the Leg after Intraosseous (IO) Needle Insertion. Ann Vasc Surg 2019; 65:282.e9-282.e11. [PMID: 31676383 DOI: 10.1016/j.avsg.2019.10.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/23/2019] [Accepted: 10/14/2019] [Indexed: 11/20/2022]
Abstract
Intraosseous (IO) needles are used in patients who are critically ill when it is not possible to obtain venous access. While IO allows for immediate access, IO infusions are associated with complications including fractures, infections, and compartment syndrome. We present a case of an 87-year-old man who developed lower extremity compartment syndrome after receiving an IO needle insertion and had to be treated surgically with fasciotomy to correct the problem.
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Intra-osseous-access-associated lower limb compartment syndrome in a critically injured paediatric patient. Eur J Anaesthesiol 2018; 35:981-983. [PMID: 30376489 DOI: 10.1097/eja.0000000000000873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Blueprint for Implementing New Processes in Acute Care: Rescuing Adult Patients With Intraosseous Access. J Trauma Nurs 2017; 22:266-73. [PMID: 26352658 DOI: 10.1097/jtn.0000000000000152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The intraosseous (IO) access initiative at an urban university adult level 1 trauma center began from the need for a more expeditious vascular access route to rescue patients in extremis. The goal of this project was a multidisciplinary approach to problem solving to increase access of IO catheters to rescue patients in all care areas. The initiative became a collaborative effort between nursing, physicians, and pharmacy to embark on an acute care endeavor to standardize IO access. This is a descriptive analysis of processes to effectively develop collaborative strategies to navigate hospital systems and successfully implement multilayered initiatives. Administration should empower nurse to advance their practice to include IO for patient rescue. Intraosseous access may expedite resuscitative efforts in patients in extremis who lack venous access or where additional venous access is required for life-saving therapies. Limiting IO dwell time may facilitate timely definitive venous access. Continued education and training by offering IO skill laboratory refreshers and annual e-learning didactic is optimal for maintaining proficiency and knowledge. More research opportunities exist to determine medication safety and efficacy in adult patients in the acute care setting.
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Malhotra R, Chua WL, O'Neill G. Calf Compartment Syndrome associated with the Use of an Intra-osseous Line in an Adult Patient: A Case Report. Malays Orthop J 2016; 10:49-51. [PMID: 28553450 PMCID: PMC5333686 DOI: 10.5704/moj.1611.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a case of a lower limb compartment syndrome associated with the use of an intra-osseous line inserted into the proximal tibia in an adult patient. An unconscious 59-year old male with multiple injuries presented to our Emergency Department after a road traffic accident. Bilateral proximal tibial intra osseous-lines were inserted due to poor venous access. After resuscitation his left leg was noted to be tense and swollen with absent pulses. Acute compartment syndrome was diagnosed both clinically and with compartment pressure measurement. Two incision fasciotomy on his left lower leg was performed. Intra osseous-lines in the proximal tibia are increasingly used in adult patients in the pre-hospital setting by paramedics and emergency physicians. Their use, along with the possible complications of these devices, such as the development of compartment syndrome or osteomyelitis leading to amputation, is well reported in the paediatric literature. To the best of our knowledge, there have not been any previous reports of complications in the adult patient. We present a case of lower leg compartment syndrome developing from the use of an intra-osseous line in the proximal tibia in an adult patient. With the increasing use of intra-osseous lines in adult patients, clinicians should be aware of the possibility of developing compartment syndrome which may lead to disability or amputation in severe cases.
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Affiliation(s)
- R Malhotra
- Department of Orthopaedics, National University Hospital Singapore, Singapore
| | - W L Chua
- Department of Orthopaedics, National University Hospital Singapore, Singapore
| | - G O'Neill
- Department of Orthopaedics, National University Hospital Singapore, Singapore
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Abstract
Time to bone healing after intraosseous (IO) insertion in children has not been clearly established. This report documents the case of a 23-month-old male infant with previous IO placement of the tibia, presenting 3 weeks later to our emergency department with radiographic evidence of previous IO insertion. This report reviews relevant literature on complications of IO insertion, contraindications to IO insertion, and evidentiary support for such recommendations. Time to bone healing after IO insertion and recommendations regarding time to safe cannulation of previously cannulated areas are based on animal models. This case demonstrates 1 instance in which radiographic evidence of bone healing at 3 weeks after IO insertion is not complete, in contradiction to previously reported data. Although the clinical significance of this finding is unknown, further work is needed to define safe timing for IO reinsertion in children.
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Johnson M, Inaba K, Byerly S, Falsgraf E, Lam L, Benjamin E, Strumwasser A, David JS, Demetriades D. Intraosseous Infusion as a Bridge to Definitive Access. Am Surg 2016. [DOI: 10.1177/000313481608201003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraosseous (IO) needle placement is an alternative for patients with difficult venous access. The purpose of this retrospective study was to examine indications and outcomes associated with IO use at a Level 1 trauma center (January 2008–May 2015). Data points included demographics, time to insertion, intravenous (IV) access points, indications, infusions, hospital and intensive care unit length of stay, and mortality. Of 68 patients with IO insertion analyzed (63.2% blunt trauma, 29.4% penetrating trauma, and 7.4% medical), 56 per cent were hypotensive on arrival and 38.2 per cent asystolic. The most common indications for IO infusion were difficult IV access (69%) and rapid sequence intubation (20.6%). The median time to IO access was three minutes. IV access was gained after IO in 72.1 per cent of patients. Through IO access, 30.9 per cent patients received crystalloid, 29.4 per cent received Advanced Care Life Support (ACLS) medications, 25 per cent rapid sequence intubation medications, 20.6 per cent blood products, and 2.9 per cent seizure medications. Overall, 80.9 per cent were intubated in the Emergency Department (ED), 26.5 per cent had ED thoracotomy, and 20.6 per cent had a laparotomy. Median crystalloid infused through IO was 180 cc in pediatric patients and 1 L in adults, respectively. Extravasation, the most common complication, was experienced by 7.4 per cent of patients. Inhospital mortality was 72.9 per cent. IO access should be considered when there is a need for rapid intervention requiring vascular access.
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Affiliation(s)
- Megan Johnson
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
| | - Saskya Byerly
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
| | - Erika Falsgraf
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Elizabeth Benjamin
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
| | - Aaron Strumwasser
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
| | - Jean-Stephane David
- Department of Anesthesia and Intensive Care, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Benite and Lyon Sud School of Medicine, Claude Bernard Lyon 1 University, Oullins, France
| | - Demetrios Demetriades
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
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Abstract
Abstract
Intraosseous vascular access is a time-tested procedure which has been incorporated into the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation. Intravenous access is often difficult to achieve in shock patients, and central line placement can be time consuming. Intraosseous vascular access, however, can be achieved quickly with minimal disruption of chest compressions. Newer insertion devices are easy to use, making the intraosseous route an attractive alternative for venous access during a resuscitation event. It is critical that anesthesiologists, who are often at the forefront of patient resuscitation, understand how to properly use this potentially life-saving procedure.
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d'Heurle A, Archdeacon MT. Compartment Syndrome After Intraosseous Infusion Associated with a Fracture of the Tibia: A Case Report. JBJS Case Connect 2013; 3:e20. [PMID: 29252325 DOI: 10.2106/jbjs.cc.l.00231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Albert d'Heurle
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of Cincinnati, PO Box 670212, Cincinnati, OH 45267-0212. .
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Abstract
Intraosseous cannulation is an increasingly common means of achieving vascular access for the administration of fluids and medications during the emergent resuscitation of both paediatric and adult patients. Improved tools and techniques for intraosseous vascular access have recently been developed, enabling the healthcare provider to choose from a wide range of devices and insertion sites. Despite its increasing popularity within the adult population, and decades of use in the paediatric population, questions remain regarding the safety and efficacy of intraosseous infusion. Although various potential complications of intraosseous cannulation have been theorized, few serious complications have been reported. This article aims to provide a review of the current literature on intraosseous vascular access, including discussion on the various intraosseous devices currently available in the market, the advantages and disadvantages of intraosseous access compared to conventional vascular access methods, complications of intraosseous cannulation and current recommendations on the use of this approach.
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Affiliation(s)
- James H Paxton
- Department of Emergency Medicine, Detroit Medical Center, Detroit, MI, USA
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Khan L, Anakwe R, Murray A, Godwin Y. A severe complication following intraosseous infusion used during resuscitation of a child. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.injury.2011.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Intraosseous line use, complications, and outcomes among a population-based cohort of children presenting to California hospitals. Pediatr Emerg Care 2011; 27:928-32. [PMID: 21960092 DOI: 10.1097/pec.0b013e3182307a2f] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Intraosseous line (IO) use has been described in prehospital settings, with some studies in the emergency department (ED). However, population-based studies describing IO line use across diverse ED and hospital settings are sparse, and the true incidence of complications remains unknown. METHODS This was a retrospective cohort study using administrative data from 450 California hospitals and EDs. We included all children aged 0 to 18 years with ED or inpatient visits from 2005 through 2007. CPT (Current Procedural Terminology) and ICD-9 (International Classification of Diseases, Ninth Revision) codes were used to identify IO line use. ICD-9 diagnosis codes were searched for potential complications related to IO line use including compartment syndrome, fracture, and osteomyelitis. Descriptive statistics were used to calculate incidence of use, outcomes, and hospital setting with IO line use. RESULTS Two hundred ninety-one children had IO lines placed in 90 hospitals, including 239 in the ED and 52 inpatient. There were 6,660,564 pediatric ED visits and 2,276,231 pediatric admissions, resulting in an incidence of IO line placement of 0.04 per 1000 ED visits and 0.02 per 1000 admissions. Mortality was 37% among patients with IO line placement. The most common diagnoses included cardiac arrest (34%), trauma (19%), and respiratory failure (6%). Types of hospital in which IO lines were placed included children's hospitals 14%, general hospitals 86%, and rural hospitals 7.9%. No complications were identified. CONCLUSIONS The overall incidence of IO line use in the ED and hospital setting is low, but IO line access is used in a variety of different hospital and ED settings for high-acuity conditions. No IO line complications were identified.
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Singh Tomar RP, Gupta A. Resuscitation by Intraosseous Infusion in Newborn. Med J Armed Forces India 2011; 62:202-3. [PMID: 27407899 DOI: 10.1016/s0377-1237(06)80078-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2004] [Accepted: 01/12/2005] [Indexed: 11/15/2022] Open
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Intraosseous access in oral and maxillofacial surgical practice. J Oral Maxillofac Surg 2011; 69:2708-13. [PMID: 21757277 DOI: 10.1016/j.joms.2011.02.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 11/20/2022]
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Rouhani S, Meloney L, Ahn R, Nelson BD, Burke TF. Alternative rehydration methods: a systematic review and lessons for resource-limited care. Pediatrics 2011; 127:e748-57. [PMID: 21321023 DOI: 10.1542/peds.2010-0952] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Dehydration is a significant threat to the health of children worldwide and a major cause of death in resource-scarce settings. Although multiple studies have revealed that oral and intravenous (IV) methods for rehydration in nonsevere dehydration are nearly equally effective, little is known about effectiveness beyond these 2 techniques. With this systematic review we analyzed the effectiveness of nonoral and nonintravenous methods of rehydration. METHODS The Medline, Cochrane, Global Health, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for articles on intraosseous (IO), nasogastric (NG), intraperitoneal (IP), subcutaneous (hypodermoclysis), and rectal (proctoclysis) rehydration through December 2009. Only human pediatric studies that included data on the effectiveness or complications of these methods were included. RESULTS The search identified 38 articles that met the inclusion criteria: 12 articles on NG, 16 on IO, 7 on IP, 3 on subcutaneous, and none on rectal rehydration. NG rehydration was as effective as IV rehydration for moderate-to-severe dehydration. IO rehydration was effective and easy to obtain, although only 1 randomized trial was identified. IP rehydration had some benefit for moderate dehydration, although none of the trials had control groups. Limited data were available on subcutaneous rehydration, and only 1 case series showed benefit. CONCLUSIONS NG rehydration should be considered second-line therapy, after oral rehydration, particularly in resource-limited environments. IO rehydration seems to be an effective alternative when IV access is not readily obtainable. Additional evidence is needed before IP and subcutaneous rehydration can be endorsed.
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Affiliation(s)
- Shada Rouhani
- Harvard Affiliated Emergency Medicine Residency Program, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA 02114, USA.
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16
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[A compartment syndrome secondary to intraosseous infusion]. ACTA ACUST UNITED AC 2010; 30:90-1. [PMID: 21123023 DOI: 10.1016/j.annfar.2010.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 05/11/2010] [Indexed: 11/22/2022]
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Alternatives to intravenous rehydration in dehydrated pediatric patients with difficult venous access. Pediatr Emerg Care 2010; 26:529-35. [PMID: 20622637 DOI: 10.1097/pec.0b013e3181e5c00e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intravenous (IV) catheter placement in the pediatric patient population can be challenging. Many health care providers automatically choose IV fluid administration to treat dehydration, often not considering other routes. This article reviews the available literature on difficulties in obtaining IV access in the pediatric population and discusses alternative methods for fluid replacement, their respective advantages and disadvantages, and place in therapy.
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Tate LP, Berry CR, King C. Comparison of peripheral-to-central circulation delivery times between intravenous and intraosseous infusion in foals. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2003.tb00244.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mahajan R, Gupta R, Sharma A. Intra-arterial access in pediatric patients. Paediatr Anaesth 2008; 18:670-1. [PMID: 18616493 DOI: 10.1111/j.1460-9592.2008.02510.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Fluid management is a vital component in the resuscitative care of the injured child. The goal of fluid resuscitation is to restore tissue perfusion without compromising the body's natural compensatory mechanism. Recent literature has questioned the timing, type, and amount of fluid administration during the resuscitative phase. When managing a pediatric resuscitation, it is imperative to use a variety of age-appropriate physiologic parameters because reliance on blood pressure alone will lead to delayed recognition of shock. Establishing vascular access, via peripheral intravenous, central venous, or intraosseous catheter, should be a high nursing priority. Hemorrhage control and fluid resuscitation of an injured child remains a top priority of trauma care. Early intravenous access with appropriate fluid administration continues to be a universal treatment for the hypotensive trauma patient. Fluid resuscitation in the early phase of care, whether in the field, emergency department, or operating room, should be targeted toward perfusing critical organs, such as the brain and heart. Once obvious bleeding is controlled, the overall goal for fluid management centers on maintaining oxygen delivery to perfuse vital structures with enough oxygen and energy substrates to maintain cellular function, thus avoiding tissue ischemia. However, specific issues around timing and type of fluid administration, once thought to be straightforward, have triggered increasing investigation of current beliefs.
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Abstract
This is a review article of intraosseous infusion methods and devices.
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Smith R, Davis N, Bouamra O, Lecky F. The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients. Injury 2005; 36:1034-8; discussion 1039. [PMID: 16054145 DOI: 10.1016/j.injury.2004.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2004] [Accepted: 11/12/2004] [Indexed: 02/02/2023]
Abstract
Intraosseous lines are a reliable and rapid tool for obtaining vascular access in emergency situations, particularly in children. Their use is recommended when intravenous access cannot be easily secured and there is a need for fluid or pharmacological resuscitation. Training in this technique is included in the Advanced Trauma Life Support (ATLS) and Advanced Paediatric Life Support course (APLS) provider courses. The objective of this study is to analyse the national use of intraosseous lines in paediatric trauma in England and Wales. Data has been collected from the Trauma Audit and Research Network (TARN) group longitudinally over 14 years from 1988 to 2002. From 23,489 paediatric trauma cases, intraosseous lines were used in only 129 patients. Compared with the remainder of the paediatric data, we found that these were the younger (1-6 years), more severely injured patients (higher ISS, lower GCS, higher head, thorax, and abdominal AIS). The mortality of these patients was high at 64% compared with 4% overall. IO line use was greater in general than in Paediatric hospitals, perhaps due to good intravenous access skills in paediatric centres. We recommend that intraosseous line use should be a skill available to everybody involved in paediatric trauma resuscitation, particularly those who may not have refined paediatric intravenous cannulation skills.
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Affiliation(s)
- Robert Smith
- North West Deanery, 6 Broadoaks Road, Sale, Cheshire M33 7SR, UK.
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Clinical review: vascular access for fluid infusion in children. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:478-84. [PMID: 15566619 PMCID: PMC1065040 DOI: 10.1186/cc2880] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completly replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access.
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Vassalos A, Rana B, Patterson PR, Grigoris P. Compartment syndrome--current trends in Scottish practice. Scott Med J 2003; 48:82-4. [PMID: 12968513 DOI: 10.1177/003693300304800306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The results are reported of a postal survey into current trends in the management of compartment syndrome and the use of compartment pressure monitoring (CPM) within Scottish trauma units. The majority of consultants in the study felt that all patients, especially the obtunded, with suspected compartment syndrome should be diagnosed using a combination of clinical review and CPM. 73% had CPM devices available representing an increase of 27% compared with previously published UK data. 43% improvised a device using a standard CVP/Arterial-line, transducer and monitor. Marked variation in threshold pressure was noted with the majority recommending perfusion pressure (PP) of diastolic blood pressure (DBP)--intracompartmental pressure (ICP) < 30 mmHg for intervention. We have found no published evidence to suggest that CPM in itself is harmful. Although a marked variation in intervention threshold exists in the literature, we would support a perfusion pressure of < 30 mmHg as being a safe, familiar and conservative intervention threshold, particularly when used in conjunction with clinical assessment.
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Affiliation(s)
- A Vassalos
- University Department of Orthopaedics, Western Infirmary, Dumbarton Road, Glasgow G11 6NT
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Olsen D, Packer BE, Perrett J, Balentine H, Andrews GA. Evaluation of the bone injection gun as a method for intraosseous cannula placement for fluid therapy in adult dogs. Vet Surg 2002; 31:533-40. [PMID: 12415522 DOI: 10.1053/jvet.2002.34658] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the Bone Injection Gun (BIG) for placement of intraosseous cannulas through impact penetration and compare it with a standard Jamshidi bone marrow needle (JBMN) and to compare fluid delivery dynamics through each device. STUDY DESIGN Randomized in vivo study. ANIMALS Forty-eight mature dogs. METHODS During surgical laboratories, dogs were randomly assigned to 2 groups (n = 24), and intraosseous access in the proximal tibial metaphysis was obtained using a BIG or JBMN. Variables measured during placement included insertion success, time required for placement, and alterations in respiratory rate (RR), heart rate (HR), and systolic blood pressure. After placement, maintenance fluids were administered to 6 dogs from each group, and fluids were administered under pressure to 6 dogs from each group to compare rates of delivery through each device. After euthanasia, the tibiae were harvested to evaluate and compare the morphologic consequences of needle and cannula placement. RESULTS Successful placement occurred in 20 (83%) dogs for the BIG and 23 (96%) dogs for the JBMN, which was not significantly different (P =.3475). Time required for placement was significantly less (P =.0024) for the BIG (mean, 22.4 +/- 8.2 seconds) compared with the JBMN (mean, 42.0 +/- 28.1 seconds). Significant increases in RR occurred in both groups and in the HR for the BIG group, but significant differences were not noted between groups. Mean rate of pressurized fluid administration was similar for both groups. Two distinct patterns of cortical bone damage occurred, but the clinical significance of this observation is uncertain. CONCLUSIONS The BIG provides more rapid access to the intraosseous space for fluid administration than the JBMN. CLINICAL RELEVANCE The BIG is an effective alternative for obtaining rapid access to the intraosseous space for emergency fluid and drug administration.
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Affiliation(s)
- Dennis Olsen
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan 66506, USA
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Alam HB, Punzalan CM, Koustova E, Bowyer MW, Rhee P. Hypertonic saline: intraosseous infusion causes myonecrosis in a dehydrated swine model of uncontrolled hemorrhagic shock. THE JOURNAL OF TRAUMA 2002; 52:18-25. [PMID: 11791047 DOI: 10.1097/00005373-200201000-00006] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Institute of Medicine has recommended intraosseous (IO) infusion of 7.5% hypertonic saline (HTS) for combat casualties in shock. We tested the safety and efficacy of this recommendation in a long-term survival model of uncontrolled hemorrhagic shock using dehydrated swine. METHODS Fourteen dehydrated Yorkshire swine had placement of a 12G needle in the right anterior tibia under isoflurane anesthesia. Uncontrolled hemorrhage was induced via left iliac artery and vein injury. Animals were kept in shock for 2 hours and then resuscitated over 2 hours with 5 mL/kg of 7.5% HTS given either as 10 small boluses (group I, n = 4) or two large boluses (group II, n = 6) to compare the physiologic response and blood loss. Control animals (group III, n = 4) received an equal volume of 0.9% saline IO and additional intravenous saline to equalize the salt load in all groups. RESULTS The three groups had similar physiologic responses, with no increase in blood loss following HTS resuscitation. However, between the second and fifth postresuscitation days, the 7.5% HTS resuscitated animals developed soft tissue necrosis or bone marrow necrosis of the right hind leg (group I, 100%; group II, 66.6%; group III, 0%). CONCLUSION HTS resuscitation effectively restored hemodynamic stability in dehydrated swine without increased bleeding from an uncontrolled vascular injury. However, IO infusion of HTS in this model was associated with a very high rate of local complications. Further investigations should be undertaken before IO use of 7.5% HTS in humans.
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Affiliation(s)
- Hasan B Alam
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
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Orgiler Uranga PE, Navarro Arnedo JM, De Haro Marín S. [The intraosseal route. When the veins have disappeared]. ENFERMERIA INTENSIVA 2001; 12:31-40; quiz 41-6. [PMID: 11459537 DOI: 10.1016/s1130-2399(01)78008-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to demonstrate the usefulness of the intraosseal route in providing emergency vascular access, especially in children, when vascular access through peripheral or central routes is difficult or impossible. A literature review revealed that the intraosseal route provides rapid, easy and effective access to the vascular system, especially in children under the age of 6 years. This route is indicated when, in emergencies, peripheral or central cannulation is too slow and the child's life is at risk. The most appropriate sites of insertion are the proximal or distal segments of the tibia and the distal segment of the femur. The administration of fluids, electrolytes and drugs through the intraosseal route is similar to that through the venous route. Complications are rare, the most serious being compartmental syndrome. In addition to providing an alternative route for the infusion of drugs and other substances into the bloodstream, the intraosseal route also provides access to the vascular system when samples for laboratory investigations are required. In conclusion, the intraosseal route provides rapid, safe and easy access to the vascular system. Complications are infrequent and there are few contraindications.
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Affiliation(s)
- P E Orgiler Uranga
- Diplomados en Enfermería Unidad de Cuidados Intensivos Pediátricos, Spain
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28
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Chiang VW, Baskin MN. Uses and complications of central venous catheters inserted in a pediatric emergency department. Pediatr Emerg Care 2000; 16:230-2. [PMID: 10966338 DOI: 10.1097/00006565-200008000-00003] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the incidence, indications, insertion sites, duration, and complications of central venous catheter (CVC) insertion in patients in a pediatric emergency department (ED). DESIGN Retrospective chart review. SETTING ED of an urban pediatric teaching hospital. SUBJECTS Patients who had a CVC inserted in the ED from January 1992 to July 1997. RESULTS During the 5.5-year study period, 121 patients were identified. Indications for insertion were cardiac/respiratory arrest in 20 patients (17%), lack of peripheral vascular access in 78 (64%), and inadequate peripheral vascular access in 23 (19%). Presenting diagnoses included cardiac/respiratory arrest (20), dehydration (19), lower respiratory tract disease (15), seizure (15), sepsis (13), trauma (10), and other (29). Prior to the CVC insertion, 80 (66%) patients had no venous access, 28 (23%) had a peripheral intravenous catheter, and 13 (11%) had an intraosseous needle. One hundred one (83%) CVCs were inserted into the femoral vein, 12 (10%) into the subclavian, 7 (6%) into the internal jugular, and 1 (1%) into an axillary vein. There were four reported complications requiring the CVC to be removed, and all occurred with femoral line placement. There were no long-term sequelae or life-threatening or limb-threatening complications (95% CI = 0-2.5%). CONCLUSIONS Central venous catheterization, particularly using the femoral approach, appears to a safe method of obtaining central venous access in the critically ill infant, child, or young adult.
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Affiliation(s)
- V W Chiang
- Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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29
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Herman MI, Chyka PA, Butler AY, Rieger SE. Methylene blue by intraosseous infusion for methemoglobinemia. Ann Emerg Med 1999; 33:111-3. [PMID: 9867898 DOI: 10.1016/s0196-0644(99)70427-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intraosseous administration of methylene blue may be an emergency alternative to intravascular administration. A 6-week-old female infant (3 kg) presented to the emergency department after a 1-week illness and appeared cyanotic and listless. Oxygen saturation by oximetry was 86% while the patient was receiving oxygen. Vital signs were blood pressure, 107/80 mm Hg; pulse, 190; respirations, 47; temperature, 39.0 degreesC. A metabolic acidosis and a methemoglobin level of 29.3% were present. After several unsuccessful attempts to establish intravenous access, an intraosseous needle was placed in the infant's left tibia. Methylene blue, 1 mg/kg, normal saline solution, and sodium bicarbonate were given intraosseously. The patient's oxygen saturation rose to 98% to 100%, and her cyanosis improved. Three hours later, her methemoglobin level was 8.2%. The child recovered uneventfully and was sent home after 3 days. Intraosseous administration of standard intravenous doses of methylene blue rapidly terminated the effects of acquired methemoglobinemia.
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Affiliation(s)
- M I Herman
- Southern Poison Center, LeBonheur Children's Medical Center, and The University of Tennessee, Memphis 38163, USA
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30
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Abstract
Raised intracompartmental pressure (ICP) has become recognized as the final common pathway of a variety of pathologies which lead to failure of the microcirculation with resultant tissue hypoxia and cell death. While commonly seen after trauma, either accidental or operative, raised ICP may result from either an increase in the volume of tissue within a closed osseo-fascial or fascial compartment or by the application of an external force compressing a compartment, and it is associated with a wide variety of insults. The advent of reproducible techniques of measuring ICP has added science to a well-recognized clinical picture and allowed a rational approach to management. Controversies still remain, particularly in regard to the level of pressure at which intervention becomes mandatory, and the role of prophylactic interventions. This review attempts to present current thinking on the pathophysiology of the microcirculation and the background to these controversies.
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Affiliation(s)
- M Mars
- University of Natal Medical School, Congella, KwaZulu Natal, Republic of South Africa.
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31
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Abstract
In children, raised intracompartmental pressure which may lead to a compartment syndrome is relatively common and follows a wide variety of insults. Cell viability is compromised at much lower compartmental pressures than in adults, and clinical awareness must be heightened, especially in the hypotensive child. Suspicion follows an awareness of clinical situations associated with the risk of raised compartmental pressure. Clinical confirmation may be difficult in the context of the uncooperative child. Diagnosis is established by invasive pressure monitoring. Intervention becomes mandatory when the compartmental pressure has risen to within 30 mmHg of the mean arterial pressure, which varies with the age and clinical status of the child. Management is by fasciotomy which should be wide and open and decompress all affected compartments. Thirty children with raised intracompartmental pressure are reported: 21 children were managed non-operatively and nine underwent fasciotomy. Two children with absolute intracompartmental pressures of 28 mmHg and 35 mmHg required fasciotomy, whereas five children with intra-compartmental pressures between 30 mmHg and 44 mmHg were managed non-operatively. In this latter group this policy resulted in no demonstrable morbidity.
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Affiliation(s)
- M Mars
- University of Natal Medical School, Durban, South Africa
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32
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Abstract
A variety of pearls, pitfalls, and updates related to the extremities and spine are discussed. Tricks of the trade regarding shoulder dislocations, easily missed fractures, radial head subluxation, and the approach to deep lacerations are discussed. In the pitfall section, potential difficulties in the evaluation of suspected nonaccidental trauma, compartment syndromes, partial cord syndromes, and hip pain in children are discussed. Finally, new information regarding cost-effective evaluation of knee and ankle injuries, as well as advances in ultrasound evaluation of shoulder and extremity injuries, is presented in the clinical updates section.
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Affiliation(s)
- K A Graeme
- Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona, USA
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33
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Benson LS, Sathy MJ, Port RB. Forearm compartment syndrome due to automated injection of computed tomography contrast material. J Orthop Trauma 1996; 10:433-6. [PMID: 8854323 DOI: 10.1097/00005131-199608000-00012] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Automated injection of computed tomography contrast material can produce a compartment syndrome if extravasation occurs. Unconscious patients and the elderly may be at particular risk. Selection of nonionic contrast material, careful evaluation of the intravenous administration site, and close monitoring of the patient during use of a power injector may help minimize or prevent extravasation injuries.
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Affiliation(s)
- L S Benson
- Department of Orthopaedic Surgery, Northwestern University Medical School, Chicago, Illinois, USA
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34
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Erb T, Hampl KF, Frei FJ. An unusual complication of intra-osseous infusion during paediatric resuscitation. Anaesthesia 1995; 50:471. [PMID: 7793564 DOI: 10.1111/j.1365-2044.1995.tb06015.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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