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Results for “Infusions, Intraosseous”

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PubMed1995

[Intraosseous infusion in children].

BACKGROUND: Intravenous access in critically ill patients may be very difficult to obtain. The intraosseous route is an alternate way to administer fluids and drugs. CASE REPORT: A five month old infant was brought to the emergency department in profound hypovolemia requiring immediate tracheal intubation. A peripheral venous access was established and 35 ml of colloid were rapidly infused. Unfortunately, fluid extravasated and the intravenous line had to be removed. As further attempts to gain intravenous access were unsuccessful, an intraosseous needle was inserted into the left tibia 1 cm below the tibial tuberosity, and colloid and human albumin solution were infused rapidly, followed by 1.4% sodium bicarbonate. After ninety minutes of intraosseous rehydration, 2 peripheral venous lines were inserted, and the intraosseous needle was removed. Bacteriological and viral cultures were negative. Four days after admission, the child was discharged in good condition. CONCLUSIONS: Intraosseous infusion provides safe, rapid and reliable access to the circulation for administration of fluids and drugs in the critically ill child or during cardiac arrest.

Emergencies↗

PubMed1997

Intraosseous infusion in an emergency situation: a case report.

An 18-month-old boy who had cardiopulmonary arrest secondary to penicillin anaphylaxis was successfully resuscitated by intraosseous administration of emergency resuscitative medications because peripheral vascular access was impossible. He was discharged 2 weeks later in a satisfactory clinical condition.

Adult↗

PubMed1992

Long-term local effects of intraosseous infusion on tibial bone marrow in the weanling pig model.

The weanling pig model was used to determine the long-term local effects, if any, on tibial bone marrow after intraosseous (IO) infusion of resuscitation fluid and drugs at standard dosages. One of six IO treatments (two normal saline boluses [20 mL/kg]; bolus sodium bicarbonate [1 mEq/kg]; 10% sodium bicarbonate infusion at a maintenance rate for 1 hour; bolus 1:10,000 epinephrine [0.01 mg/kg]; 1:10,000 epinephrine solution infusion, 1 microgram/kg/min for 1 hour; or dopamine infusion, 10 micrograms/kg/min for 1 hour) was randomly administered via the left tibia to 18 pigs at 4 weeks of age. The animals were subsequently followed for 3 months, after which marrow from the same space and peripheral blood were examined. Marrow from the right tibia of each animal served as control; untreated historic controls were also used for comparison. Examination of the marrow revealed normal cell differentials in all limbs in all groups. Overall cellularity was somewhat decreased in the experimental limbs of the normal saline bolus group when compared with same-animal control limbs, perhaps due to the pressure effect from rapid injection. Peripheral blood counts and differentials in these and all other animals were normal. The authors conclude that IO administration of commonly used resuscitative medications does not result in significant adverse effects in the tibial bone marrow in this model.

Animals↗

PubMed1992

Use of an implant for intraosseous infusion as supportive therapy for a Vietnamese pot-bellied pig with urethral obstruction caused by a polyp.

A Vietnamese pot-bellied pig with a urethral polyp was supported by total parenteral nutrition given through an intraosseous implant. Peripheral vascular access was difficult to establish and maintain in this anorectic pig, so a pediatric intraosseous implant was placed in the left tibia. Surgical repair of the urethra was not considered possible, and alternative techniques of a functional bypass were unacceptable to the owners, so euthanasia was elected. Histologic examination of the urethra revealed a polypoid structure believed to be similar to benign congenital polyps described in young boys.

Animals↗

PubMed1998

Successful use of an intraosseous infusion in an 800 grams preterm infant.

An intravascular access line for the administration of life support drugs and volume expanders may be particularly difficult, especially in very small premature babies. We report on the successful use of an intraosseous accessline in an 800 grams preterm infant for the administration of drugs and fluid. The use and technique of an intraosseous access is an important emergency alternative which may be lifesaving, even in very preterm babies, when other methods fail.

Atropine↗

PubMed1979

Intraosseous infusion: pressure-flow relationship and pharmacokinetics.

In order to quantitatively investigate the usefulness of intraosseous fluid and drug administration as a resuscitative modality, we studied the infusion flow rates of crystalloid solutions obtainable at varying infusion pressures into the bovine tibial medullary cavity and time to initial as well as 90% of maximal effect of intraosseously administered vasoactive drugs. Mean infusion rates +/- SEM (n = 6) at 300, 200, and 100 torr and atmosphere + 81 cm H2O were 41 +/- 2, 32 +/- 1, 27 +/-2, and 10 +/- 1 ml/min, respectively. The mean time (+/- SEM) to initial effect of intraosseous injections (n = 6) of either 0.5 mg epinephrine or 50 mg ephedrine was 17 +/- 3 seconds and mean time to 90% of maximal effect was 45 +/- 5 seconds. These results provide a quantitative basis for resuscitation by fluid and drug administration via the tibial malleolar intraosseous route and suggest that when performed in appropriate situations, the technique may have clinical utility.

Animals↗

PubMed1986

Intraosseous infusion of phenytoin.

In the critically ill child, administration of fluids and medications via the intraosseous route often proves life-saving. The authors describe the case of a child with status epilepticus in whom phenytoin was administered via the intraosseous route, and seizure resolution and therapeutic serum levels were achieved. Intraosseous drug administration should be reserved for the rare critically ill child in whom vascular access proves impossible.

Child, Preschool↗

PubMed1989

Prehospital use of intraosseous infusion by paramedics.

Vascular access in young children frequently proves difficult in the prehospital setting. To assess the feasibility of training paramedics in the placement of intraosseous (IO) lines as an alternative to intravenous (IV) access, this pilot project studied a training program and treatment protocol for prehospital IO use. Paramedics underwent a training program in IO placement. Patients enrolled were less than five years of age and in cardiac arrest. During a 10-month period, paramedics attempted 12 IO placements, of which 10 (85%) were successful, nine on the first attempt. Although no patients achieved long-term survival, three were initially resuscitated from arrest. Paramedics can be trained in IO placement, and IO infusion can be used in prehospital pediatric care. Training methods, limitations, and implications for future use are discussed.

Adolescent↗

PubMed1991

Intraosseous infusion of fluids in the initial management of hypovolemic shock in young subjects.

Immediate aggressive fluid resuscitation of a child with life-threatening hemorrhagic shock provides the difference between life and death. Obtaining venous access in the hypovolemic child sometimes is difficult and time consuming. In order to evaluate the benefit of prehospital administration of intraosseous fluids into the tibial bone marrow as a method of gaining quick access to the systemic circulation and in resuscitating victims from severe hypovolemic shock, 13 puppies weighing 4.6 to 10 kg were subjected to progressive, controlled exsanguination until their mean arterial pressure (MAP) was 20% or less of their baseline MAP for 5 minutes (maxishock). Then an 18-gauge intraosseous needle was inserted into the tibial bone marrow and lactated Ringer's solution was infused at 300 mm Hg of pressure until a volume three times the blood loss had been administered. The MAP, central venous pressure, arterial blood gases, hematocrit, serum lactate, and urine output were recorded at 10, 20, 30, 45, 60, 90, and 120 minutes after the onset of maxishock. At the end of the experiment the left lung of each animal was sent to the pathology department to investigate the possibility of bone marrow emboli. The results were compared with a group of control dogs with maxishock and no treatment, and a group of dogs with maxishock treated with a canine military antishock trousers inflated to 50 to 55 mm Hg and no fluids. The average needle insertion time was 16 seconds; the rate of infusion of fluids varied from a maximum of 25.7 mL/min to a minimum of 4.5 mL/min, with a mean of 10.6 mL/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

Intraosseous infusions: an important but forgotten method of vascular access.

Patients with malignancies or other prolonged illnesses such as acquired immune deficiency syndrome, require long-term vascular access. Unfortunately, currently available technologies which access the vascular system, such as intravenous catheters (external or implanted ports), have frequent complications including clotting and infection which limit their long-term usefulness. An important but forgotten method to access the central venous system is through the intraosseous route. This review summarizes past experience with the intraosseous route of access to the central venous system as well as describes a new device which might eventually make intraosseous access more convenient for the patient. It is anticipated this forgotten method of vascular access will be used more frequently in patients who have exhausted conventional venous access systems.

Bone Marrow↗

PubMed1983