Intraosseous access using butterfly needle

Alternative rehydration methods: a systematic review and lessons for resource-limited care

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.

Infant intraosseous infusion

Neonatal health care providers are fortunate that the umbilical cord generally provides easy intravenous (IV) access for newborn patients. Outside of the immediate newborn period, however, it may be impossible to obtain peripheral or umbilical IV access in critically ill newborns. Intraosseous (IO) infusion is not widely used in the neonatal population, but is a viable option when IV access cannot be established quickly. This article examines IO infusion devices and placement sites and addresses assessment and care of the infant receiving IO fluids and medications.