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Results for “Infusions, Intraosseous”

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PubMed1995

Effect of haemorrhagic shock and intraosseous resuscitation on plasma and urine catecholamine concentrations and urinary clearance in pigs.

OBJECTIVE: To evaluate the plasma and urinary catecholamine concentrations after episodes of haemorrhagic shock treated by intraosseous infusion of a small volume of hyperosmotic fluid, followed by whole blood, in a standard porcine model. DESIGN: Randomised open study. SETTING: University hospital, Norway. MATERIAL: 18 piglets. INTERVENTIONS: All animals were bled to an arterial systolic pressure of 60 mm Hg. After 30 minutes 100 ml hyperosmotic (2.4 mol/l) fluid (glucose/sodium chloride) was given either intraosseously (n = 6) or intravenously (n = 6). Ninety minutes later the animals were again bled to a systolic pressure of 60 mm Hg, and after 30 minutes an autologous whole blood transfusion was given by either intraosseous or intravenous infusion. Six animals acted as untreated controls. MAIN OUTCOME MEASURES: Changes in haemodynamic variables and plasma and urinary catecholamine concentrations. RESULTS: Two pigs in the control group died. The hyperosmotic infusion improved the circulatory performance significantly (p < 0.05). Thirty minutes after both bleeds the plasma catecholamine concentrations were increased by 10-15 times, but returned to the reference range in all groups 90 minutes after the hyperosmotic infusion. Two hours after the whole blood infusion the catecholamine concentrations of the treated animals were at baseline values, significantly lower than those of the controls. The corresponding urinary catecholamine concentrations of the controls were significantly increased. There were no differences between the two treatment groups. CONCLUSION: The catecholamine measurements indicate that there may possibly be protective renal excretion of excess shock-induced plasma catecholamines after acute haemorrhage.

Animals↗

PubMed1997

Bone marrow infusion in adults.

OBJECTIVE: To asses the feasibility and success rate of vascular access through intraosseous infusions in adults, in elective and emergency situations using a novel, automatic device, the bone injection gun. DESIGN: A prospective, nonrandomized trial. MATERIALS AND METHODS: Two groups of patients were prospectively selected over an 11-month period. Group 1: Adult patients with recent closed long bone fractures, who underwent orthopedic surgery to upper and lower limbs and needed regional anesthesia. Group 2: Adult patients who required emergency or semiemergency vascular access, in whom intravenous central or peripheral cannulation could not be established within a reasonable period of time. MAIN RESULTS: Fifty adult patients, aged 27 through 78 years, underwent the procedure, which was universally successful. In group 1, n = 31 patients; in group 2 (n = 19), 12 patients had multiple injuries, and seven underwent emergency resuscitation. In 76% of the cases, the needle was inserted into the area of the tibial tuberosity; in the reminder of the cases, the needle was inserted at the distal end of the radial bone and into the lateral or the medial malleolus. The success rate for an adequate insertion was 100% in this group of patients. No complications from the procedure were observed in this series. CONCLUSIONS: This study emphasizes the importance and feasibility of the intraosseous route for infusion of fluids and medications in emergency situations in adults. The use of an impact, high speed automatic needle insertion device provides a higher success rate of vascular access via the intraosseal route in adult patients.

Adult↗

PubMed1996

[Intraosseous device of perfusion. Apropos of 3 cases before hospitalization].

A renewal of interest in the intraosseous route has appeared lately in France. It concerns pediatric patients. After anatomophysiological and technical quotes, we report the indications, contraindications, method of supervision and complications of the placement of an intraosseous infusion. Our modest experience enables us to present three observations where intraosseous route has been used outside hospital in children suffering a cardiopulmonary arrest on arrival of the practitioner belonging to the mobile emergency unit. This rapid and easy to place technique seems to be attractive as an alternative to the intravenous route in situations of utmost emergency, this all the more so since there are few reported contraindications and complications.

Ambulances↗

PubMedDate not supplied

Intraosseous hypertonic saline solution for resuscitation of uncontrolled, exsanguinating liver injury in young Swine.

Fluid resuscitation administered before hemorrhage control for trauma victims sustaining blunt abdominal injury is controversial. Prehospital fluid resuscitation is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. Venous access is often a clinical dilemma in severely hypovolemic children. Intraosseous infusion is considered a useful technique for the administration of fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of intraosseous versus intravenous infusion of hypertonic saline solution in an uncontrolled hemorrhagic shock swine model. We also tested the effect of the different sites of infusion on the intra-abdominal bleeding. Relevant hemodynamic parameters were monitored and blood samples were collected. After liver injury, 20 anesthetized immature pigs were randomized to three groups: intraosseous access, intravenous access and control. After 20 min of uncontrolled hemorrhage, the hypertonic saline solution begins in the intraosseous access and intravenous access groups of animals. Thirty minutes later, the animals were killed and intra-abdominal blood loss was measured. All the pigs presented lower pressures and lower cardiac output after 20 min of hemorrhagic shock. The intravenous and intraosseous access groups did not show a better hemodynamic performance after 10 min of fluid resuscitation. At the end of the experiment, all animals were hemodynamically similar without an improved answer to a fluid resuscitation. There were no significant differences between groups regarding intra-abdominal blood loss. It was concluded that the hypertonic saline solution in this experimental model did not promote hemodynamic improvement and there were no differences between the two sites of fluid resuscitation regarding intra-abdominal blood loss.

Animals↗

PubMed1994

Improved prehospital pediatric ALS care after an EMT-paramedic clinical training course.

The objective was to determine the association between the performance rates of pediatric advanced life-support procedures, intubation and vascular access, by emergency medicine technician-paramedics (EMT-P), and introduction of an EMT-P pediatric advanced life support (PALS) clinical course. Prehospital EMT-P care records from January 1990 to December 1991 were retrospectively reviewed to determine endotracheal intubation and vascular access performance rates. These rates were compared with intubation and vascular access performance rates by EMT-Ps from January 1983 to June 1985. In 1986, an EMT-P PALS clinical course was introduced that included rotations during which an EMT-P trainee performed endotracheal intubation of children, under the supervision of a pediatric anesthesiologist, and vascular access, under the supervision of pediatric emergency medicine nurses and physicians. The trainees and all active EMT-Ps were taught the intraosseous infusion procedure. During January 1990 to December 1991, 193 children received prehospital endotracheal intubation attempts and 167 (87%) were intubated. Intubation performance rates for 90 children younger than 18 months of age was 90% and was 83% for 103 children > or = 18 months of age. Vascular access, intravenous or intraosseous, was established in 130 (73%) of the children; no attempt was made in 14 children. The vascular access performance rate was 64% for children younger than 18 months of age and 79% for children > or = 18 months old. Intubation performance rates of EMT-Ps before the EMT-P PALS clinical course (January 1983 to June 1985) were 48% for children younger than 18 months of age and 85% for children > or = 18 months old.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1987

A comparative study of intraosseous versus peripheral intravenous infusion of diazepam and phenobarbital in dogs.

Authors of recent literature have made several references to the use of intraosseous infusion in emergency situations. This method has provided a useful route of medication and fluid administration when peripheral IV access has been unsuccessful. Controlled studies on intraosseous infusion have been limited. To more accurately evaluate the effectiveness of this technique, we administered diazepam to 20 dogs randomly assigned to either peripheral IV (n = 10) or tibial intraosseous (n = 10) groups. Intramedullary placement usually was performed within 15 seconds. Central venous diazepam samples were collected at one-, three-, six-, ten-, and 20-minute intervals. Intraosseous infusion achieved and maintained serum diazepam levels comparable to those achieved by IV administration. This study was repeated with phenobarbital using a different set of 20 dogs with samples collected at one-, three-, six-, and ten-minute intervals. Results were similar in that the levels were comparable regardless of the use of intraosseous or IV administration. Complications using this technique have been few. When peripheral IV access is unobtainable, intraosseous infusion has been shown to be an effective and efficient alternative for administering medications and fluids.

Animals↗

PubMed2006

[Intraosseous access in adults--an alternative if conventional vascular access is difficult?].

Intraosseous infusion is widely used in children, but its use in adults is much less common. This is probably because another vascular access can usually be achieved, and also because of lack of knowledge of the technique. Placement in adults is a quick procedure with a high rate of success. Drugs and fluids do not change the pharmacodynamics or pharmacokinetics of intraosseous administration, and anything can be given. Infusion rates have been achieved that in part make fluid resuscitation possible. Its uses are many and the contraindications few; complications are rare when simple guidelines are followed.

Adult↗

PubMed2000

Discovery of the intraosseous route for fluid administration.

One of the many problems in the resuscitation of the shocked patient is how to gain access to the circulation to provide fluids or drugs. Since the 1830s fluids have been administered intravenously. Intravenous access is not always possible in the very shocked patient. An alternative, used in the first world war, was the rectal route. This has rarely been used on a large scale since. Just before the outbreak of the second world war a chance discovery resulted in the development of intraosseous infusions of fluid and drugs. From its discovery it was used in adults and children. For many years it seemed to be ignored in adult resuscitation, but there are now signs of renewed interest in the technique. This brief review traces the discovery of the intraosseous route to put the current developments into a historical context.

Fluid Therapy↗

PubMed1989

Intraosseous crystalloid and blood infusion in a swine model.

The technique of intraosseous infusion has attracted increasing interest in recent years, and has proven valuable for drug administration. This study was undertaken to determine whether it was also a potential route for fluid resuscitation. Thirteen- or eighteen-gauge tibial intraosseous needles were placed in eight "large" (mean weight, 14.4 kg) and eight "small" (mean weight, 5.8 kg) swine and the flow rate of blood and saline measured under gravity and 300 mm Hg. Flow was significantly greater using 13-gauge needles in the "large" swine, significantly greater for saline than for blood, and for pressure infusion versus gravity in all animals. A fluid bolus of 20 ml/kg could be given to all animals in less than 10 minutes using pressure infusion. These data suggest that intraosseous infusion is a reasonable initial step in fluid resuscitation of pediatric subjects until more conventional vascular access has been established.

Animals↗

PubMedDate not supplied

[Use of heparin in the early post-traumatic period in burns and hemorrhage].

Experiments on dogs (n = 86) revealed that a combined injury led to marked disorders in the hemostasis, manifesting by third-degree syndrome of disseminated intravascular coagulation which develops as early as at the height of injury. Infusion therapy, particularly making use of intravenous polygluquin, led to progress of chronological and structural hypocoagulation and hypofibrinogenemia. Heparin in a dose of 25 to 30 U/kg b.w. reduced the severity of hypocoagulation shifts, this manifesting by a shorter time of some coagulation tests and suppression of intravascular platelet aggregation. A manifest trend to normalization of plasma and platelet hemostasis was observed 3 h after the onset of infusion therapy. This trend was more manifest if intraosseous infusion of isotonic NaCl solution was used.

Animals↗

PubMed1993

Bone changes associated with intraosseous hypertension in the caprine tibia.

We investigated the effects of increased intraosseous pressure on new-bone formation in the proximal metaphysis of the caprine tibia. Intraosseous hypertension was produced by obstruction of venous outflow by ligation of the popliteal vein draining the proximal aspect of the tibia and occlusion of the medullary space with bone cement (groups 1 and 2). After the obstruction of venous outflow (day 0), the intraosseous pressure measured at the proximal tibial metaphysis increased significantly from a mean of 15.5 millimeters of mercury before the obstruction to a mean of 28.7 millimeters of mercury in groups 1 and 2. In group 1, obstruction of venous outflow was combined with intraosseous infusion of autogenous whole blood under pressure to maintain the intraosseous pressure between thirty and forty-five millimeters of mercury during days 0 through 5. The time for venous drainage was still prolonged and intraosseous pressures were still increased on days 5 and 10 (means, 26.8 and 26.2 millimeters of mercury, respectively) in groups 1 and 2. The intraosseous hypertension produced in group 1 was associated with a significant increase in periosteal (138 per cent), endocortical (369 per cent), and cancellous new-bone formation (889 per cent) at the tibial metaphysis compared with control values. Osseous necrosis within the metaphysis was not observed.

Animals↗

PubMed1995

Vascular access in neonates and infants--indications, routes, techniques and devices, complications.

Venous cannulation has been in regular use in neonates since the 1940s. This was at first through the umbilical vein, but the frequency of complications lead to other central and peripheral routes being used for infusion of fluid, nutrients and drugs. Today, peripheral venous access is preferred except for high volume fluid resuscitation, reliable infusion of irritant drugs and long-term parenteral nutrition. Intraosseous infusion provides a reliable alternative to peripheral veins for rapid infusion of fluid. Long, thin silastic catheters can be inserted through a peripheral venous cannulae for parenteral nutrition or other central venous infusions as an alternative to direct central venous cannulation using the Seldinger or other techniques. Broviac or Hickman catheters, inserted through a subcutaneous tunnel are only considered when central venous cannulation is likely to be needed for more than six weeks. The most common serious complication of vascular access is infection. Infection associated with central venous catheters is reduced by prophylactic vancomycin or teicoplanin. Other complications of central venous infusion are associated with cannulae malpositioning, bleeding and thrombosis. Distal hypoperfusion may follow arterial cannulation. Modern emergency and intensive care paediatrics is impossible without adequate venous and arterial vascular access. However no other skill for neonatal intensive care causes more anxiety in primary care providers or is more difficult to teach.

Anti-Bacterial Agents↗

PubMed1990

Intraosseous succinylcholine for orotracheal intubation.

Within the past few years, the use of intraosseous infusions has increased as a means of achieving rapid vascular access. Although initially used for fluid administration, the intraosseous administration of several drugs has been shown to be an effective alternative to the intravenous route. We present two cases of the intraosseous administration of succinylcholine (1 mg/kg) for emergency airway management in children. Intraosseous succinylcholine resulted in adequate intubating conditions within 45 seconds.

Bone Marrow↗

PubMed1994

Distribution of clindamycin in cortical bone during direct local infusion of the canine tibia.

The distribution of clindamycin in tibial cortical bone, administered via direct local infusion with an implantable pump, is described. Clindamycin concentrations in cortical bone were measured after 3, 7, and 21 days of intraosseous infusion. The tibia were divided into four quadrants relative to the outflow infusion catheter site located in the medial aspect of the mid-diaphysis. A gradient of 5-30 mm from the infusion site was documented in all four quadrants (proximal lateral, proximal medial, distal lateral, and distal medial). At all sampling times, clindamycin concentrations in all quadrants exceeded the minimum inhibitory concentrations for gram-positive aerobic bacteria, including Staphylococcus aureus and S. epidermidis, and both the gram-positive and gram-negative anaerobes, including Peptostreptococcus species and Bacteroides species. The data suggest that gravitational forces affect the diffusion of the clindamycin because concentrations in both distal quadrants were greater than in corresponding proximal quadrants.

Animals↗

PubMed1990

Comparison study of intraosseous, central intravenous, and peripheral intravenous infusions of emergency drugs.

Intraosseous infusion of emergency drugs is a lifesaving alternative to intravenous administration when intravenous access cannot be rapidly established. We studied the comparative pharmacokinetics of the following six emergency drugs and solutions: epinephrine hydrochloride, 0.01 mg/kg; sodium bicarbonate, 1 mEq/kg; calcium chloride, 10 mg/kg; hydroxyethyl starch, 10 mL/kg; 50% dextrose in water, 250 mg/kg; and lidocaine hydrochloride, 1 mg/kg. Studies were conducted in normotensive, anesthetized dogs, with three animals studied with each of the drugs or solutions and each animal being treated with all three routes of administration (central intravenous, peripheral intravenous, and intraosseous) in randomized sequence. The effects of epinephrine were also assessed in a shock model. The intraosseous route of administration was comparable with the central and peripheral intravenous routes for all of the emergency drugs and solutions studied, with equivalent magnitudes of peak effect or drug level and equal or longer durations of action. Time to placement of the intraosseous needle varied from 15 seconds to 5 minutes, with a mean of 60 seconds. Time to placement of the needle varies with the skill and experience of the individual. With experience, all individuals could place the intraosseous needle in 60 seconds or less. The intraosseous route is comparable in effect to the central and peripheral intravenous routes of drug administration for epinephrine, sodium bicarbonate, hydroxyethyl starch, calcium chloride, 50% dextrose in water, and lidocaine and is a clinically feasible alternative when intravenous access will be critically delayed.

Animals↗

PubMedDate not supplied

Bilateral lower extremity compartment syndromes secondary to intraosseous fluid resuscitation.

Intraosseous infusions are reserved for use in life-threatening hypovolemic or cardiogenic shock when intravenous (i.v.) access cannot be readily established. Although minor fluid extravasation is a common problem with this technique, a fully established compartment syndrome has never been reported. We describe a child with severe compartment syndromes of both lower extremities complicating the use of intraosseous fluid resuscitation.

Bone and Bones↗

PubMed1991

[Intra-osseous infusion--a simple, rapid and lifesaving method].

One of the major challenges in the initial treatment of critically ill or injured patients is the establishment of a well functioning intravenous access. This can be very difficult in patients with circulatory collapse, and almost impossible in infants. Central venous cannulation is time-consuming and requires skill. Nor can intratracheal and rectal administration of drugs and fluids fully replace the intravascular route. In such situations the old but forgotten technique of intraosseous infusion represents an elegant and easy way of gaining rapid intravascular access. The method is simple, safe and almost foolproof, and can easily be performed under field conditions, e.g. by paramedical personnel. Very few contra indications exist, and the success rate even by untrained personnel is high. In this review the physiological aspects and the technique itself is discussed and illustrated by case reports.

Aged↗

PubMed2000

Can blood taken from intraosseous cannulations be used for blood analysis?

Intraosseous infusion is increasingly finding application for venous access to infuse drugs and fluids in paediatric resuscitation including burns. The aim of this study was to determine the feasibility of using blood samples taken from the bone marrow cavity for routine blood analysis. In paediatric resuscitation where alternative venous access is not available this could prove valuable. Peripheral venous blood samples were compared with blood obtained from the bone marrow cavity in patients undergoing bone marrow aspiration for the investigation of possible medical pathology. Haemoglobin, haematocrit, sodium, urea, creatinine, and calcium levels values were sufficiently similar to be clinically useful. The potassium level was elevated in most bone marrow samples and the difference from peripheral venous samples variable. Great caution should be exercised in their interpretation. Glucose levels should also be interpreted with care. In conclusion, blood samples obtained intraosseously may give a useful guide to peripheral blood levels of some haematological and biochemical variables. This is potentially useful where a peripheral venous sample cannot be obtained. The values must be interpreted with care. Whether these findings can be extended to paediatric patients who are not haemodynamically stable has not been assessed.

Blood Chemical Analysis↗