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At least 19 recordsLinked to original sources
PubMed1994

Compartment syndrome secondary to prolonged intraosseous infusion.

Intraosseous infusions are a valuable means of establishing intravascular access in pediatric emergencies. We report a case of compartment syndrome from prolonged intraosseous infusion (53 hours). We postulate that chemical irritation from medications, infections, the tenuous nature of intraosseous infusions, and the use of infusion pumps may all play a role in the development of compartment syndrome. We recommend that, when possible, intraosseous lines be used only temporarily until more permanent vascular access is established, that lines that do not flow with gravity be removed, and that drugs known to cause chemical burns be used with caution. In addition, the use of x-ray and hourly measurement of leg circumference may help to determine whether a line is still in place. Also, given the changing circumstances and technology under which intraosseous infusions are used, new prospective studies of their complications are needed.

Compartment Syndromes↗
PubMedDate not supplied

Intraosseous infusion.

Intraosseous infusion is recommended for children aged 6 years or less who have life-threatening conditions and require vascular access which cannot be achieved in a timely manner via another route. It is a reliable, safe procedure with a complication rate of less than 1%.

Age Factors↗
PubMed1998

The calcaneum as a site for intraosseous infusion.

Intraosseous infusion has been recommended as a rapid and effective form of circulatory access in the collapsed child. Recognised sites for insertion include the tibia, femur, iliac crest, sternum, and clavicle. The case of a 3 year old collapsed child is described who was successfully resuscitated with the use of an intraosseous needle placed in the calcaneum; the method of needle insertion is also detailed.

Calcaneus↗
PubMed1999

Pharmacokinetics and pharmacodynamics of hydroxyethyl starch in hypovolemic pigs; a comparison of peripheral and intraosseous infusion.

Intraosseous (i.o.) infusion is considered a useful technique for the administration of medications and fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of i.o. versus intravenous (i.v.) infusion of hydroxyethyl starch (HES 200/0.5) in hypovolemic pigs. Twenty-three pigs (8- to 9-week-old) were anaesthesized, instrumented and blood was withdrawn (25-30 ml/kg) to < 50 mmHg mean arterial pressure (MAP). The animals were left untreated in haemorrhage for 30 min. Relevant haemodynamic parameters were monitored and blood samples were collected for blood gas and HES concentration analysis. Infusion of HES via i.v. or i.o. line (20 ml/kg per h) carried out over a period of 30 min for volume resuscitation and measurements were taken every 5 min. Infusion was discontinued after 30 min and the animals were monitored for 1 h. Analysis of HES-pharmacokinetics and pharmacodynamics revealed no significant differences between i.o. and the i.v. administration. The results demonstrate i.o. infusion of HES to be a rapid and effective method for fluid resuscitation in hypovolemic shock.

Animals↗
PubMed1991

Emergency resuscitation in children. The role of intraosseous infusion.

Intraosseous infusion is a temporary procedure for use in pediatric emergencies when intravenous access is difficult. Multiple drugs and fluids can be safely administered through the intraosseous route. Dosage and rate of infusion are essentially the same as with intravenous infusion.

Child, Preschool↗
PubMedDate not supplied

Intraosseous infusion.

Intraosseous infusion has been documented for many decades to be a safe, fast, and effective method of fluid and medication administration. Complications are infrequent and the benefits generally far outweight the risks. Described in this article are: anatomic considerations, absorption, indications, complications, use in cardiopulmonary arrest, and insertion techniques.

Bone and Bones↗
PubMed1997

Tibial length following intraosseous infusion: a prospective, radiographic analysis.

Intraosseous infusion is a well accepted means of obtaining emergency intravascular access in children. Despite the low incidence of serious complications from intraosseous infusions, the potential exists for growth plate injury and subsequent growth disturbance following intraosseous infusion. We conducted a prospective, blinded observational study of 10 subjects to evaluate tibial length discrepancy radiographically one year or more following intraosseous infusion. We found no significant difference in mean tibial length between the legs that had intraosseous infusions and the opposite legs, which served as controls. We conclude that intraosseous infusion does not appear to produce subsequent leg length discrepancy one year after infusion.

Child, Preschool↗
PubMed1992

Intraosseous infusion in infants and children.

Intraosseous infusion was used extensively for the parenteral administration of blood, fluids, and pharmacological agents in the 1940s. The technique was "discovered" and popularized again during the 1980s. Substances injected intraosseously are found rapidly in the central circulation. Drugs should be given in the equivalent dose used for intravenous administration. The preferred site for intraosseous infusion is the proximal tibia. Insertion is performed 1 to 3 cm below the tibial tuberosity on the flat anteromedial surface of the tibia. After about 5 years of age, the distal tibia or femur are the preferred sites. Needles made specifically for resuscitative intraosseous infusion are available. Increased awareness of the role of intraosseous infusion, familiarity with the technique of insertion, and careful use of landmarks to guide insertion should minimize complications.

Child↗
PubMed1991

Intraosseous infusion of dobutamine and isoproterenol.

Intraosseous infusion has been advocated as an emergency route in sick infants and children when intravenous access is not readily obtainable. Dobutamine hydrochloride and isoproterenol hydrochloride are useful emergency drugs that have not been studied when administered into the bone marrow. In a swine model, we compared the physiologic responses (heart rate, arterial pressure, and cardiac output) of dobutamine and isoproterenol infusions delivered intravenously and intraosseously during 20-minute intervals. We observed statistically significant effects of both dobutamine and isoproterenol delivered by the intraosseous route. In addition, the effects resulting from intraosseous infusion were statistically similar to those resulting from intravenous administration of these drugs. We conclude that the intraosseous infusion of dobutamine and isoproterenol is an effective and useful method for emergency administration of these medications.

Animals↗
PubMed1988

Intraosseous infusion of hypertonic glucose and dopamine.

Intraosseous infusion of drugs for resuscitation and of fluids has been advocated as an alternate emergency technique to intravenous infusion. The reliability of intraosseous infusion of many substances has not been established. Glucose and dopamine hydrochloride are two commonly used emergency drugs in pediatric practice that have not been carefully studied when administered into the bone marrow. In an animal model, we compared the response of an intraosseous injection of hypertonic glucose with that of an intravenous injection of hypertonic glucose. Serum glucose measurements following the injection revealed both routes of administration to be effective. A dopamine infusion was then administered through the bone marrow for 20 minutes. A statistically significant rise in blood pressure was observed two minutes after initiation of the infusion. Intraosseous infusion of hypertonic glucose and dopamine is an effective route by which to administer these medications and is potentially useful in emergency situations in which intravascular access is delayed.

Animals↗
PubMed1992

[Intraosseous infusions in children].

Tibial intraosseous infusions can be invaluable in the management of the pediatric patient who is in cardiac arrest or severe shock when vascular access by the intravenous route is unattainable. Recently there has been renewed interest in this procedure. There is a small risk of complications.

Child, Preschool↗
PubMed2004

Intraosseous infusions via the calcaneus.

OBJECTIVES: To demonstrate that intraosseous infusions via the calcaneus could deliver fluids to systemic veins and that intraosseous infusions do not require bones with medullary cavities. To demonstrate that intraosseous infusions could be successful in adults. DESIGN: Ten adult cadavers were injected with 16 gauge intraosseous needles and infused with 10 ml of methyl green dye at a concentration of 10 mg/ml. MAIN OUTCOME MEASURES: Observation of methyl green dye in the great saphenous, medial malleolar and dorsal veins of the foot recorded by digital photography on injection and at 1 min post-injection. RESULTS: Immediate entry of methyl green dye into the superficial veins of the leg was seen in 14 out of the 20 legs trialled and delayed entry was noted in the two legs of another cadaver. No venous entry was seen in one cadaver and intraosseous access failed in one cadaver. CONCLUSIONS: Successful intraosseous infusions can be performed via the calcaneus. Intraosseous infusions can be successful in adult populations. While not a substitute for intraosseous infusions in other sites, the calcaneus provides an easily accessible site free of overlying vital structures.

Adult↗
PubMed1986

Intraosseous infusions: a usable technique.

Intraosseous infusions were widely used in pediatric patients during the 1930s and 1940s. Recent reports have re-introduced this concept and confirmed its safety and ready accessability for fluid and drug administration. However, these reports have not addressed the difficulties encountered during insertion of the intraosseous needle. Spinal needles, standard metal intravenous (IV) needles, and bone marrow biopsy needles have been suggested for intraosseous infusion. These needles were tested for ease of insertion on a pediatric cadaver leg. The site for needle placement was also evaluated during the study. It was found that the 13-gauge Kormed/Jamshidi disposable bone marrow/aspiration needle was the easiest to insert and did not plug with bone or tissue during insertion. An area proximal to the medial malleolus was found to provide a stable, relatively flat, and easily penetrable location for needle placement. This method was successfully utilized in ten pediatric and five adult patients. Intraosseous needle placement is a safe, rapid method to gain access to the venous circulation. By utilizing these techniques, a stable, usable fluid line can be established in even the most dehydrated pediatric patients.

Bone Marrow↗
PubMed1991

A prehospital model of intraosseous infusion.

STUDY OBJECTIVE: Before the implementation of an intraosseous infusion protocol by the City of Pittsburgh paramedics, we undertook a study to compare the establishment of a simulated intraosseous infusion in three different prehospital settings. The purpose of this study was to determine the time to establish an intraosseous infusion and the success rate at the scene and en route to the hospital using this model. DESIGN: Prospective study. SETTING: Three prehospital scenarios: classroom (scene); a medic unit traveling at 25 mph and making slow, steady turns (turns); and a medic unit traveling at 30 to 35 mph with sudden stops and starts (stop and go). TYPE OF PARTICIPANTS: Paramedics and emergency medicine residents. MEASUREMENTS AND MAIN RESULTS: Successful placement of the IO needle was confirmed by the aspiration of marrow or the free flow of 5 to 10 mL of normal saline without extravasation into the surrounding tissue. The procedure was timed from skin entry to establishment of infusion. All participants were successful in establishing IO infusion, with 84.8% of infusions achieved in less than one minute in all settings. The scene had somewhat shorter mean and median times and a higher first-attempt success rate, but the differences between scenarios were not significant. CONCLUSION: Using a simulated model, IO access can be established successfully in the prehospital setting. The minimal time delay in establishing IO infusion may make it an appropriate technique for use at the scene or en route to the hospital.

Allied Health Personnel↗
PubMed1993

Use of intraosseous infusion in the pediatric trauma patient.

Intraosseous infusions (IO) are frequently used for gaining rapid vascular access in critically ill children. Few studies exist evaluating the efficacy of this procedure in the injured child. The objective of this study was to describe one pediatric institution's experience with the procedure of IO in young trauma victims. This study evaluated indications, insertion sites, complications, infused pharmacological agents, age, injury severity, and outcome. Fifteen patients received IO placement for cardiopulmonary arrest, seven for hypovolemic shock, and five for neurological compromise. Patient ages ranged from 3 months to 10 years (mean, 2.9 years). Twenty-nine IO lines were attempted in the tibia and three in the femur. Four of 32 attempts were unsuccessful. Of 32 attempts at IO placement (5 patients received multiple attempts), 15 were started in the prehospital setting and 17 in the emergency department. Multiple resuscitation medications as well as large colloid, crystalloid, and blood boluses were successfully infused. Seven of the 27 patients survived without observed IO-related complications. This study supports the use of IO infusion by prehospital as well as hospital personnel in the initial resuscitation of critically injured children. IO has a been established as a rapid, safe, and simple method of obtaining short term vascular access in both critically ill and injured children. This route deserves primary consideration as an alternate route for fluid resuscitation in pediatric trauma patients regardless of age. IO should be placed without delay when venous access is not rapidly obtainable.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion↗
PubMed2003

Successful intraosseous infusion in the critically ill patient does not require a medullary cavity.

OBJECTIVES: To demonstrate that successful intraosseous infusion in critically ill patients does not require bone that contains a medullary cavity. DESIGN: Infusion of methyl green dye via standard intraosseous needles into bones without medullary cavity-in this case calcaneus and radial styloid-in cadaveric specimens. SETTING: University department of anatomy. PARTICIPANTS: Two adult cadaveric specimens. MAIN OUTCOME MEASURES: Observation of methyl green dye in peripheral veins of the limb in which the intraosseous infusion was performed. RESULTS: Methyl green dye was observed in peripheral veins of the chosen limb in five out of eight intraosseous infusions into bones without medullary cavity-calcaneus and radial styloid. CONCLUSIONS: Successful intraosseous infusion does not always require injection into a bone with a medullary cavity. Practitioners attempting intraosseous access on critically ill patients in the emergency department or prehospital setting need not restrict themselves to such bones. Calcaneus and radial styloid are both an acceptable alternative to traditional recommended sites.

Adult↗
PubMed1990

Evaluation of an intraosseous infusion device for the resuscitation of hypovolemic shock.

An intraosseous infusion device designed for the prehospital administration of hypertonic saline-dextran solutions was evaluated by resuscitating hemorrhaged conscious sheep. Eight animals underwent 2 hours of hemorrhagic hypotension (50 mm Hg, bled volume = 43 +/- 7 ml/kg). This was followed by the intraosseous infusion of 200 ml (4-5 ml/kg) of 7.5% NaCl-6% dextran 70 into the bone marrow of the sternum. Results were compared to seven control animals (bled volume = 31 +/- 6 ml/kg) resuscitated through a central venous catheter. Despite the small volumes infused, mean arterial blood pressure and cardiac output were rapidly normalized in both groups by 10 minutes post resuscitation (p less than 0.01). Plasma sodium concentration increased an average of 12 mEq/L and plasma volume was rapidly expanded regardless of route. The metabolic acidosis of hemorrhagic shock was rapidly corrected, pulmonary pressures remained normal, and hypoxemia did not occur after intraosseous resuscitation. The device provided safe and rapid vascular access via the sternal bone marrow space. The use of intraosseous infusion of hypertonic saline dextran solutions via the sternal bone marrow may allow prehospital rescuers to consistently incorporate fluid replacement therapy into 'scoop and run' policies by avoiding the time delays associated with failures in IV access.

Animals↗