Intraosseous infusion

From WikiLectures

Intraosseous infusion in cases where it is necessary to ensure access to the bloodstreamn which cannot be ensured even with a line. All drugs, including solutions and blood derivatives, can be administered intraosseously. The speed of onset of action is comparable to central venous access. It is most often used in pre-hospital care, in hospitals it can help in urgent situations, especially if it is not possible to cannulate the central vein reliably and quickly.

A certain disadvantage is the painful application, the need for special cannulae and the limited time of possible use - 6-12, exceptionally a maximum of 24 hours of use are mentioned. The pain during bone penetration is overestimated, it is comparable or less than skin puncture with a wider cannula (Gronych 2014).

Indication[edit | edit source]

Intraosseous Infusion

Contraindications[edit | edit source]

Approches[edit | edit source]

  • humeral head (suitable for resuscitation)
  • proximal part of the tibia at the site of tuberositas tibiae (children < 6 years)
  • distal femur
  • calcaneus (newborns and children < 6 months)

Proximal tibial procedure[edit | edit source]

  • the patient is in the supine position
  • We support the slightly bent lower limb so that the lower leg rests on a firm base (i.e. to ensure good stabilization of the lower leg)
  • the injection site is the proximal part of the tibia, approximately 2 cm medial and 2 cm proximal (distal in children) from the tuberositas tibiae , strict aseptic conditions must be ensured during the procedure
  • perpendicular to the long axis of the bone, we penetrate the bone matrix and penetrate the bone marrow with a helical movement (penetration into it is associated with a loss of resistance), the depth of injection is usually 1-1.5 cm

After introducing[edit | edit source]

  • the needle is in the correct position when it rests firmly in the bone and when we aspirate the marrow
  • in a conscious patient, we very slowly apply 2 ml of local anesthetic
  • if we think we are in the right position, but the bone marrow cannot be aspirated, we flush the needle with 10 ml (children 2-5 ml) of physiological solution and observe whether there is an arching
  • first bolus forcefully within 5 sec loosening of trabecular bone (No flush = no flow)
  • if everything is without problems, fix the needle and cover it sterilely

Complications[edit | edit source]

  • superficial infections
  • osteomyelitis
  • subperiosteal infusion
  • compartment syndrome
  • transient appearance of blasts in peripheral blood
  • needle dislocation and subsequent bleeding
  • according to some authors, fat embolism in adult patients
  • damage to growth cartilage in children

Video[edit | edit source]

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Links[edit | edit source]

References[edit | edit source]

  • ŠEVČÍK, Pavel, et al. Intenzivní medicína. 3. edition. Galén, 2014. 1195 pp. pp. 100. ISBN 9788074920660.

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