Intraosseous Vascular Access

imagesUsed as emergent vascular access for fluid resuscitation and drug infusion when unable to obtain peripheral venous access


imagesPrimarily used in pediatric cardiac arrest—generally a faster access than central line in infants or children


imagesUsed in adult resuscitation if other forms of vascular access cannot be established


CONTRAINDICATIONS



imagesAbsolute Contraindications


   imagesFracture at the insertion site


imagesRelative Contraindications


   imagesPrevious attempt to place intraosseous (IO) needle on the same bone


   imagesOsteogenesis imperfecta


   imagesOsteoporosis


   imagesOverlying infection, burn, or skin damage at insertion site


RISKS/CONSENT ISSUES



imagesPain (local anesthesia can be given)


imagesLocal bleeding and hematoma


imagesGrowth plate injuries or fractures


imagesExtravasation of fluid or drugs through iatrogenic fracture/puncture site


imagesOsteomyelitis and cellulitis



imagesGeneral Basic Steps


   imagesSterilize


   imagesAnesthesia


   imagesPlace IO


LANDMARKS



imagesStandard placement of the IO line is 1 to 2 cm distal to the tibial tuberosity on the anteromedial aspect of the tibia (FIGURE 25.1)


imagesAlternate sites for placement


   imagesMedial aspect of the distal tibia approximately 1 to 2 cm proximal to the medial malleolus (FIGURE 25.2)


   imagesAnterior aspect of the distal femur just proximal to the junction of the femoral shaft and the lateral and medial condyles


TECHNIQUE



imagesSterilize the insertion site with povidone–iodine solution, chlorhexidine, or alcohol


imagesIf the patient is awake, administer a local anesthetic to the skin and periosteum


imagesFor manual IO insertion:


   imagesGrasp the IO needle in the palm of the hand using the index finger and thumb to guide and stabilize the needle



images


FIGURE 25.1 Entry site at the proximal tibia. (From Hodge D III. Intraosseous infusion. In: King C, Henretig F, eds. Textbook of Pediatric Emergency Procedures. Baltimore, MD: Williams & Wilkins; 2008.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Intraosseous Vascular Access

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