intraosseous needle insertion dr. mohamed haseen basha dr. mohamed haseen basha assistant professor...
TRANSCRIPT
Intraosseous needle insertion
Dr. Mohamed Haseen BashaAssistant professor
( Paediatrics)Faculty of Medicine
Al Maarefa College of Science and Technology
Indications
• Obtain emergency access in children during life-threatening
situations. cardiopulmonary arrest, shock, burns, and life-
threatening status epilepticus.
• IO line can be used to infuse medications, blood products, or
fluids.
Contraindications
• Osteogenesis imperfect • Osteoporosis • Clotting disorders.• Fractures in the target bone • Previous orthopaedic surgery near the insertion site • Previous IO insertion in the target bone within the preceding
48 hours • Infection at the insertion site
Anatomy
• The bone marrow cavity has an extensive virtually non-
collapsible vascular network which communicates directly
with the systemic circulation.
• Medications or fluids given by the IO route diffuse a few
centimetres through the medullary cavity then enter the
venous circulation.
• The IO needle should be removed once adequate vascular
access has been established.
SitesProximal Tibia• Anteromedial surface of the proximal tibia, 2 cm below and 1
to 2 cm medial to the tibial tuberosity on the flat part of the bone
Distal Tibia• Medial surface of the distal tibia 1 to 2 cm above the medial
malleolus (may be a more effective site in older children)
Distal femur
• 3 cm above the lateral condyle in the midline
Equipment required
• sterile gloves and gown
• basic dressing pack
• antiseptic to prepare the skin
• rigid needle with an inner stylet (for patients < 18 months an
18 - 20 lumbar puncture needle can be used)
• syringe with NaCl 0.9% flush
• routine IV line tubing set-up and tape
procedure
• Immobilize the extremity.
• Prepare the site with antiseptic.
• Consider need to use local anaesthetic( 0.5-1 mL 1% lignocaine )
if time permits.
• Insert the needle:Hold the needle handle in the palm of the
hand while the thumb and forefinger grip the shaft about a
centimetre from the point to stabilize the needle.
• Apply firm pressure while using a screwing or rotary action
until the bone cortex is traversed.
• Note that at approximately 1cm or less below the skin
surface, a distinct loss of resistance on entry of the bone
marrow is felt.
• Blockage of the needle may occurr if an inner stylet
is not used.
Three indicators of successful insertion
• A distinctive pop with insertion, or a give or release of
resistance is felt.
• The needle flushes without significant subcutaneous
infiltration and bone marrow is easily aspirated.
• The needle stands without support.
After successful insertion
• Once insertion is confirmed: Unscrew and remove the stylet.
• Attempt bone marrow aspiration (bone marrow can be used
as a substitute for venous blood for estimation of PCO2, pH,
Hb, electrolytes, urea, creatinine, proteins etc).
• Flush the needle with 5-10 mL of normal saline to decrease
the cellularity of the surrounding marrow, aiding subsequent
infusions.
• Attach IV tubing and commence the infusion of medications
or fluids by pump.
Absorption• Recommended intravenous rates for drugs and fluids can be
administered via the IO route and reach the central circulation
in equivalent times.
Strong alkaline and hypertonic solutions should be diluted
before use.
complications• fracture of the target bone• infection• extravasation• subperiosteal infusion• embolism• compartment syndrome• pain on use• dislodgement• skin necrosis