Intraosseous Infusions
Mary E. Revenis
Lamia Soghier
A. Indications
1. Emergency intravenous access in hospital or during prehospital transport (1) when other venous access is not readily available; to restore intravascular volume so that peripheral venous access becomes possible. In delivery room resuscitation simulation settings, intraosseous access can be established more quickly than umbilical venous catheterization (2, 3). See Table 56.1 for categories of fluid and medications that have been infused (4, 5, 6, 7, 8, 9).
TABLE 56.1 Types of Intraosseous Infusates | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| |||||||||||
1. Bone without cortical integrity (fracture, previous penetration): Extravasation of infusate
2. Sternal site: Potential damage to heart and lungs (20)
3. Overlying soft tissue infection or burn
4. Osteogenesis imperfecta
5. Obliterative diseases of marrow such as osteopetrosis
C. Equipment (Fig. 56.1)
Sterile
1. Surgical gloves
2. Antiseptic swabs
3. Gauze squares
4. Aperture drape
5. 1% lidocaine in 1-mL syringe with 25-gauge needle
a. Bone marrow or intraosseous needle (18-gauge) (stylet and adjustable depth indicator preferred)
b. Short spinal needle with stylet (18- or 20-gauge)
c. Short hypodermic needle (18- or 20-gauge) (13)
d. Butterfly needle (16- to 19-gauge) (22)
7. 5-mL syringe on a three-way stopcock and IV extension set with clamp
8. Intravenous infusion set and intravenous fluid
9. 5-mL syringes with saline flush solution
Optional
Intraosseous needle placement device (intended for use at the proximal tibial location). Devices approved for newborns are the battery-operated driver EZ-IO PD (Pediatric) (Vidacare,
San Antonio, TX, USA) (approved for 3 kg or larger), and the spring-activated (pediatric) B.I.G. Bone Injection Gun (WaisMed, Houston, TX, USA). There are company-provided reports of use in delivery rooms and intensive care nurseries. Published information on use of these devices in small premature infants is scarce. There is limited information on the incidence of success or complications when using these devices, as compared with manual insertion of the intraosseous needle (23).
San Antonio, TX, USA) (approved for 3 kg or larger), and the spring-activated (pediatric) B.I.G. Bone Injection Gun (WaisMed, Houston, TX, USA). There are company-provided reports of use in delivery rooms and intensive care nurseries. Published information on use of these devices in small premature infants is scarce. There is limited information on the incidence of success or complications when using these devices, as compared with manual insertion of the intraosseous needle (23).
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