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PubMed1999

Intraosseous lines in preterm and full term neonates.

AIM: To evaluate the use of intraosseous lines for rapid vascular access in primary resuscitation of preterm and full term neonates. METHODS: Thirty intraosseous lines were placed in 27 newborns, in whom conventional venous access had failed. RESULTS: All the neonates survived the resuscitation procedure, with no long term side effects. CONCLUSION: Intraosseous infusion is quick, safe, and effective in compromised neonates.

Asphyxia Neonatorum↗
PubMedDate not supplied

[Intraosseous route in pediatric emergencies. Description of 2 clinical cases and review of the literature].

The Authors describe the intraosseous administration of drugs and fluids in two patients: a preterm infant (gestational age 26 weeks, weight 850 g) with severe cardiopulmonary depression just after delivery, and a 15-day-old newborn with bronchopneumonia. The intraosseous infusion is safe and effective. At present, mainly in United States, it has an important role in pediatric emergency. It is indicated in all emergency situations where a vascular access must be rapidly obtained and in whom other methods of access to the vascular system have failed. After a short review on the history of this old procedure, used for the first time in 1922 for blood transfusions, the Authors describe its physiology, technique, complications, and contraindications.

Bicarbonates↗
PubMed1999

[Retrospective study of 32 cases of intraosseous perfusion].

BACKGROUND: We studied all intraosseous infusions performed between 1994 and 1997 by the pediatric intensive care unit and by the pre-hospital emergency medical staff in the Hôpital d'Enfants, Toulouse, France. POPULATION AND METHODS: We report 32 cases of intraosseous infusions in 30 children aged 2 weeks to 9 years. RESULTS: In our population, such a technique has been used in about 60% of all cardiopulmonary arrest, drowning or traffic accident cases. Intraosseous infusion was successful in all cases, on the first attempt in more than 80% of cases. Nine children recovered without any sequelae. No major complications have been observed. CONCLUSIONS: Intraosseous infusion is safe, rapid and effective. It is an essential alternative route in pediatric resuscitation when no other venous access can be performed quickly. An effort must be made on behalf of its diffusion and teaching.

Accidents, Traffic↗
PubMedDate not supplied

A comparative study of peripheral to central circulation delivery times between intraosseous and intravenous injection using a radionuclide technique in normovolemic and hypovolemic canines.

Intraosseous infusion is considered a useful technique for administration of medications and fluids in emergency situations when peripheral intravascular access is unobtainable. This study examined the effectiveness of intraosseous infusion for delivery of substances to the central circulation. Central deliveries of a radionuclide tracer administered by the intraosseous and intravenous routes were evaluated during normovolemic and hypovolemic states. Intraosseous infusion achieved peripheral to central circulation transit times comparable to those achieved by the intravenous route. Analysis of variance revealed no statistically significant differences between the peripheral to central delivery times comparing intraosseous and intravenous administration. The results demonstrate that intraosseous infusion is a rapid and effective method of delivery to the central circulation and is an alternative method for intravascular access. This study also suggests that a radionuclide tracer is useful for the evaluation of transit times following intraosseous injection.

Animals↗
PubMed1997

Hypertonic saline dextran (HSD) and intraosseous vascular access for the treatment of haemorrhagic hypotension in the far-forward combat arena.

Battlefield statistics show that 50% of deaths are due to acute haemorrhage. Hypertonic (7.5% saline)/hyperoncotic (6% Dextran-70) solution (HSD) for the treatment of haemorrhagic hypotension may have physiologic and logistic advantages over conventional fluid therapy for use in the far-forward combat arena. HSD rapidly expands plasma volume and stabilizes haemodynamic variables in various animal models of haemorrhage, at a volume dose of about 1/10 of conventional lactated Ringers solution. However, combat conditions, as well as the physiological status of the patient may result in time delays or failure to achieve vascular access. Over the past 5 years we have investigated intraosseous infusion of HSD via the sternum or tibia, as a possible means of achieving rapid vascular access and plasma volume expansion. These data in experimental animals and one clinical study show that HSD can be safely and rapidly infused via the intraosseous route achieving the same haemodynamic benefit as observed with intravenous administration.

Animals↗
PubMed2002

Comparison of intraosseous or intravenous infusion for delivery of amikacin sulfate to the tibiotarsal joint of horses.

OBJECTIVE: To establish the route of infusion (IV or intraosseous) that results in the highest concentration of amikacin in the synovial fluid of the tibiotarsal joint and determine the duration of peak concentrations. ANIMALS: 21 horses. PROCEDURE: Regional perfusion of a limb on 15 horses was performed. Amikacin sulfate was infused into the saphenous vein or via intraosseous infusion into the distal portion of the tibia (1 g in 56 ml of lactated Ringer's solution) or proximal portion of the metatarsus (1 g of amikacin in 26 ml of lactated Ringer's solution). Amikacin concentrations were measured in sequential samples from tibiotarsal joint synovial fluid and serum. Samples were obtained immediately prior to release of the tourniquet and 0.5, 1, 4, 8, 12, and 24 hours after the tourniquet was released. Radiographic contrast material was infused into the same locations as the antibiotic perfusate to evaluate distribution in 6 other horses. RESULTS: Infusion into the saphenous vein produced the highest concentration of amikacin in the tibiotarsal joint, compared with the distal portion of the tibia (mean +/- SE, 701.8 +/- 366.8 vs 203.8 +/- 64.5 microg/ml, respectively). Use of a lower volume of diluent in the proximal portion of the metatarsus produced a peak value of 72.2 +/- 23.4 microg/ml. CONCLUSIONS AND CLINICAL RELEVANCE: For regional perfusion of the tarsus, IV infusion is preferred to intraosseous infusion, because higher concentrations are achieved in the synovial fluid, and the procedure is easier to perform.

Amikacin↗
PubMed1994

Intraosseous extravasation complication reports.

We report two cases of severe complications from intraosseous infusions. One child was a sudden infant death syndrome patient who developed severe tissue necrosis after intraosseous placement. The second child was a near drowning who developed a compartment syndrome requiring fasciotomy. Extravasation is a potentially major complication that resulted in these limb-threatening events. Intraosseous infusion remains an important resuscitation modality, but great care must be taken to avoid these results. Strategies for avoiding extravasation are discussed.

Child, Preschool↗
PubMedDate not supplied

Training prehospital personnel in saphenous vein cutdown and adult intraosseous access techniques.

OBJECTIVE: To compare the success rates, complication rates, and times required for paramedic students to perform saphenous vein cutdown and adult intraosseous infusion using the bone injection gun (BIG). METHODS: This was a prospective, randomized crossover study of 13 senior-level students in a baccalaureate degree paramedic program. Study subjects were instructed in adult intraosseous and saphenous vein cutdown techniques through lecture and laboratory exercises and then randomized into two groups. Group 1 performed saphenous vein cutdown at the ankle, followed by intraosseous infusion using the BIG. Group 2 performed the same procedures but in reverse order. All procedures were performed on preserved cadavers and videotaped. Using a standardized scoring sheet, the authors evaluated the study subjects at the time of the procedures to determine success rates, errors, and complications. Videotapes were later reviewed to verify the time required to complete the procedures. RESULTS: The normalized mean procedure scores were 96.15 (SD 4.28) and 83.83 (SD 15.52) for the intraosseous infusion and saphenous vein cutdown procedures, respectively (95% CI for difference in means, -12.34 to -1.3; p = 0.020). Success rates for establishing venous access were higher for the intraosseous route (92.3%) than the cutdown technique (69.2%), but did not achieve statistical significance (p = 0.250). The times required to initiate fluid flow were 3.91 minutes (SD 0.82) by the intraosseous route and 7.57 minutes (SD 1.80) by venous cutdown (95% CI for difference in means, 2.43 to 5.55; p = 0.000). One critical error and 11 noncritical errors were encountered during the intraosseous procedure, compared with ten critical errors and 29 noncritical errors during the cutdown procedure ( p = 0.195). CONCLUSION: In a group of inexperienced paramedic students working on a preserved human cadaver model, intravenous access was gained more rapidly, with a higher success rate, and with fewer complications using the bone injection gun than by the saphenous vein cutdown procedure. Further study is needed to evaluate these procedures in the field setting and to compare their feasibility with other alternative venous access techniques such as femoral, external jugular, and central venous cannulation.

Adult↗
PubMed2002

[Intravenous spondylo-infusion in the treatment of lumbar osteochondrosis].

Using the intraosseous infusion technique, 87 patients with neurological symptoms of osteochondritis of lumbosacral intervertebral disks (study group) were treated. Sixty-six patients were treated by traditional drugs (control group). The study and control groups have been matched by age (mean 45 years) and symptoms--reflex-muscular, spondilosis radicular, Charcot's syndrome. An estimation of treatment efficiency was carried out by registration of somatosensory evoked potentials and ultrasonic dopplerography of the inferior vein cava and its branches as well as by measuring of intraosseous pressure in an acantha before and after infusion of a solution. The diskogenic neurological frustrations regressed more promptly and completely in the patients, to whom the intraosseous infusion technique has been applied. The positive correlation between clinical recovery and a decrease of a latency of somatosensory evoked potentials peaks is revealed. The intraosseous pressure in an acantha after a course intraosseous infusion was reduced. The directions for applying intraosseous infusion technique are developed.

Adult↗
PubMed2005

Comparison of intraosseous and intravenous infusion of technetium Tc 99m pertechnate in the distal portion of forelimbs in standing horses by use of scintigraphic imaging.

OBJECTIVE: To describe and compare the distribution of technetium Tc 99m (99mTc) pertechnate following intraosseous or i.v. injection (with or without use of a tourniquet) in the distal portion of the forelimb in standing horses. ANIMALS: 4 horses. PROCEDURE: Each horse received 4 forelimb treatments in random sequence: intraosseous infusion with tourniquet application (IOT), intraosseous infusion without tourniquet application, i.v infusion with tourniquet application (IVT), and i.v. infusion without tourniquet application. Dynamic nuclear scintigraphic imaging of the third metacarpal bone, proximal and middle phalanges, and distal phalanx was performed from the start of each treatment until 1 hour after infusion was completed. Radionuclide activity was compared within and between treatment groups. RESULTS: Tourniquet application was necessary to maintain high levels of radionuclide activity in the distal portion of the forelimb after intraosseous or i.v. infusion with 99mTc pertechnate; IVT and IOT treatments resulted in similar radionuclide activity in the proximal and middle phalanges and distal phalanx. Of the 4 treatments, there was significantly higher radionuclide activity in the distal aspect of the third metacarpal bone after the IOT treatment. CONCLUSIONS AND CLINICAL RELEVANCE: By use of a tourniquet, radionuclide administration via the intraosseous or i.v. routes resulted in effective perfusion of the distal portion of the forelimb and similar distribution of the agent in the phalanges of horses. Further studies are required to ascertain whether these findings apply to delivery of therapeutic agents in infected tissues via IOT or IVT.

Animals↗
PubMed1979

[Treatment of acute thrombophlebitis of the lower limbs with long-term intraosseous drug infusions].

Under analysis are the results obtained in 62 patients with acute thrombophlebitis of lower extremities treated by prolonged intraosseous heparin-penicillin blockade. The acute inflammatory phenomena along the veins subsided within 2-6 days. The complete cure was observed 1,5-6,5 days earlier in cases with superficial thrombophlebitis and 4-15 days earlier in profound thrombophlebitis as compared with control.

Adolescent↗
PubMed1984

Emergency infusion of catecholamines into bone marrow.

An emergency infusion of catecholamines into the bone marrow of a 6-month-old infant was performed. We believe this is the first report of continuous intraosseous infusion of dopamine hydrochloride and dobutamine hydrochloride. Intraosseous infusions are efficacious and complications are rare. We recommend use of this technique in emergency circumstances when venous access cannot be obtained.

Bone Marrow↗
PubMed1988

Intravascular access in pediatric cardiac arrest.

All cases of patients aged less than 48 months who presented in cardiac arrest to the Hennepin County Medical Center's emergency department (ED) during the years 1984 to 1986 were reviewed retrospectively. The ED record, initial and subsequent chest radiographs, hospital charts, and autopsy reports were analyzed. A total of 33 cases were reviewed. The average patient age was 5 months. The average time needed to establish intravascular access was 7.9 +/- 4.2 minutes. Success rates were 77% for central venous catheterization, 81% for surgical vein cutdown, 83% for intraosseous infusion, and 17% for percutaneous peripheral catheterization. Percutaneous peripheral catheterization, when successful, and bone marrow needle placement were the fastest methods of obtaining intravascular access. There were no major immediate complications, and delayed complications were minimal. Attempts at peripheral intravenous catheter placement should be brief, with rapid progression to intraosseous infusion if peripheral attempts are not successful.

Bone Marrow↗
PubMed1993

Resuscitation of pigs with haemorrhagic shock by an intraosseous hyperosmotic solution and transfusion of autologous whole blood.

OBJECTIVE: To evaluate resuscitation after episodes of haemorrhagic shock by the combination of intraosseous infusion of a small volume of hyperosmotic fluid, followed by whole blood, in a standard experiment in pigs. DESIGN: Randomised open study. MATERIAL: 18 piglets. INTERVENTIONS: After a 60 minute period of stabilization all animals were bled to an arterial systolic pressure of 60 mm Hg. After 30 minutes 100 ml hyperosmotic fluid was given over a seven minute period into the tibial bone marrow (n = 6) or into an ear vein (n = 6). Ninety minutes later the animals were again bled to a systolic pressure of 60 mm Hg and 30 minutes after this they were treated by autologous blood transfusion either by intraosseous or intravenous infusion. Six animals acted as untreated controls. MAIN OUTCOME MEASURES: Changes in haemodynamic, haematological and biochemical variables. RESULTS: Two pigs in the control group died. There was no difference between the intraosseous and intravenous routes for the infusion of small volumes of hyperosmotic fluid or whole blood. There was a significant improvement in haemodynamic variables after resuscitation with intraosseous infusion of small volumes of hyperosmotic fluid (p < 0.05). CONCLUSION: Intraosseous infusions were easy to establish, and may be a useful method of resuscitation from haemorrhagic shock, particularly in children.

Animals↗
PubMed1991

Treatment of hemorrhagic shock with intraosseous or intravenous infusion of hypertonic saline dextran solution.

The efficacy of intravenous or intraosseous infusion of 250 ml of 7.5% NaCl and 6% dextran 60 (H/H) was compared with intravenous Ringer's lactate (RL) for the initial treatment of patients with hemorrhagic shock due to upper gastrointestinal bleeding. 49 patients were randomly assigned to receive either H/H (n = 26) or RL (n = 23). In the first 16 patients with H/H and in all RL patients, solutions were infused by the intravenous route, while the intraosseous route through sternal puncture was chosen for the last 10 H/H subjects. H/H patients were analyzed together since no differences were noticed between the routes of infusion. The H/H group also received 2.3 +/- 0.7 liters of intravenous crystalloid solutions in the first hour and 4.4 +/- 0.1 liters in the 24-hour period, while RL received 3.3 +/- 0.7 and 7.3 +/- 2.4 liters, respectively. Blood pressure (BP) increased during the first 15 min in the H/H group (from 61 +/- 17/30 +/- 12 to 85 +/- 30/48 +/- 14 mm Hg) and thereafter, while remaining unchanged in the RL group (from 75 +/- 18/40 +/- 12 to 75 +/- 17/40 +/- 14 mm Hg; p less than 0.05). The differences between groups were significant throughout 24 h. Urine output and improvement of the Glasgow Coma Score were also higher in H/H patients than in the control group (p less than 0.05). There were 5 deaths in RL group and 1 in the H/H group. Sternal of peripheral vein infusion of 250 ml of 7.5% NaCl/6% dextran 60 is an effective initial treatment of hemorrhagic shock.

Blood Pressure↗