Intraosseous infusion: Difference between revisions
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This route of venous access is typically used when peripheral IV is not obtainable in a timely manner and central venous access via central line is not appropriate.<ref>{{cite web |url=http://www.nda.ox.ac.uk/wfsa/html/u12/u1210_01.htm |title=Intraosseous Infusion |accessdate=2007-08-23 |format= |work=|author=Vreede E, Bulatovic A, Rosseel P, Lassalle X}}</ref> | This route of venous access is typically used when peripheral IV is not obtainable in a timely manner and central venous access via central line is not appropriate.<ref>{{cite web |url=http://www.nda.ox.ac.uk/wfsa/html/u12/u1210_01.htm |title=Intraosseous Infusion |accessdate=2007-08-23 |format= |work=|author=Vreede E, Bulatovic A, Rosseel P, Lassalle X}}</ref> | ||
Various potential locations may be used for IO catheter placement, including (but not limited to) the sternum, proximal humerus, distal femur, proximal tibia, and distal tibia. The most commonly used location in both children and adults is the proximal tibia, although the proximal humerus is gaining popularity due to decreased time to medication reaching the central venous system. | |||
==Clinical practice guidelines== | ==Clinical practice guidelines== | ||
In 2005, the [[American Heart Association]] first | In 2005, the [[American Heart Association]] first recommended intraosseous infusion as an option for delivery of resuscitation drugs, "If IV access cannot be established, intraosseous (IO) delivery of resuscitation drugs will achieve adequate plasma concentrations".<ref name="ACLS">{{cite journal |author=American Heart Association, |title=Part 4: Advanced Life Support |journal=Circulation |volume=112 |issue=22 (supplement |pages=III-25 – III-54 |year=2005 |pmid=16301345 |doi=10.1161/CIRCULATIONAHA.105.166472}}</ref> | ||
==Effectiveness== | ==Effectiveness== | ||
Revision as of 17:14, 11 August 2009
Editor-In-Chief: James H. Paxton, MD MBA, Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI [1]
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Overview
Intraosseous (IO) infusion is the injection of fluids or medications directly into the bone marrow through a specialized intraosseous needle. Fluids and medications administered via IO infusion are picked up by the venous network draining the bone marrow for delivery to the central venous circulation.
This route of venous access is typically used when peripheral IV is not obtainable in a timely manner and central venous access via central line is not appropriate.[1]
Various potential locations may be used for IO catheter placement, including (but not limited to) the sternum, proximal humerus, distal femur, proximal tibia, and distal tibia. The most commonly used location in both children and adults is the proximal tibia, although the proximal humerus is gaining popularity due to decreased time to medication reaching the central venous system.
Clinical practice guidelines
In 2005, the American Heart Association first recommended intraosseous infusion as an option for delivery of resuscitation drugs, "If IV access cannot be established, intraosseous (IO) delivery of resuscitation drugs will achieve adequate plasma concentrations".[2]
Effectiveness
This American Heart Association guideline cited two randomized controlled trials, one of 60 children[3] and one of electively cannulated hematology/oncology patients.[4] In addition, uncontrolled studies have been performed[5][6], one of which reported 72% to 87% rates of successful insertion.[5]
References
- ↑ Vreede E, Bulatovic A, Rosseel P, Lassalle X. "Intraosseous Infusion". Retrieved 2007-08-23.
- ↑ American Heart Association, (2005). "Part 4: Advanced Life Support". Circulation. 112 (22 (supplement): III-25–III-54. doi:10.1161/CIRCULATIONAHA.105.166472. PMID 16301345.
- ↑ Banerjee S, Singhi SC, Singh S, Singh M (1994). "The intraosseous route is a suitable alternative to intravenous route for fluid resuscitation in severely dehydrated children". Indian pediatrics. 31 (12): 1511–20. PMID 7875811.
- ↑ Brickman KR, Krupp K, Rega P, Alexander J, Guinness M (1992). "Typing and screening of blood from intraosseous access". Annals of emergency medicine. 21 (4): 414–7. doi:10.1016/S0196-0644(05)82661-7. PMID 1554180.
- ↑ 5.0 5.1 Frascone RJ, Jensen JP, Kaye K, Salzman JG (2007). "Consecutive field trials using two different intraosseous devices". Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 11 (2): 164–71. doi:10.1080/10903120701205851. PMID 17454802.
- ↑ Davidoff J, Fowler R, Gordon D; et al. (2005). "Clinical evaluation of a novel intraosseous device for adults: prospective, 250-patient, multi-center trial". JEMS : a journal of emergency medical services. 30 (10): suppl 20-23. PMID 16382512.