Intraosseous vascular access in critically ill adults—a review of the literature

Garside, Joanne; Prescott, Stephen; Susan, Shaw

doi:10.1111/nicc.12163

Cited by 18 publications

(8 citation statements)

References 28 publications

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“…We note that intraosseous saline injection continues to be used clinically for resuscitation. 26 , 27 We injected relatively small volumes (0.5 ml) but consider that virtually any saline injection into the delicate bone vascular tree is potentially damaging. There is now some evidence that larger volumes of intraosseous saline injection may be harmful.…”

Section: Discussionmentioning

confidence: 99%

Intraosseous pressure during loading and with vascular occlusion in an animal model

Beverly

Mellon

Kennedy

et al. 2018

Bone & Joint Research

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ObjectivesWe studied subchondral intraosseous pressure (IOP) in an animal model during loading, and with vascular occlusion. We explored bone compartmentalization by saline injection.Materials and MethodsNeedles were placed in the femoral condyle and proximal tibia of five anaesthetized rabbits and connected to pressure recorders. The limb was loaded with and without proximal vascular occlusion. An additional subject had simultaneous triple recordings at the femoral head, femoral condyle and proximal tibia. In a further subject, saline injections at three sites were carried out in turn.ResultsLoading alone caused a rise in subchondral IOP from 11.7 mmHg (sd 7.1) to 17.9 mmHg (sd 8.1; p < 0.0002). During arterial occlusion, IOP fell to 5.3 mmHg (sd 4.1), then with loading there was a small rise to 7.6 mmHg (sd 4.5; p < 0.002). During venous occlusion, IOP rose to 20.2 mmHg (sd 5.8), and with loading there was a further rise to 26.3 mmHg (sd 6.3; p < 0.003). The effects were present at three different sites along the limb simultaneously. Saline injections showed pressure transmitted throughout the length of the femur but not across the knee joint.ConclusionThis is the first study to report changes in IOP in vivo during loading and with combinations of vascular occlusion and loading. Intraosseous pressure is not a constant. It is reduced during proximal arterial occlusion and increased with proximal venous occlusion. Whatever the perfusion state, in vivo load is transferred partly by hydraulic pressure. We propose that joints act as hydraulic pressure barriers. An understanding of subchondral physiology may be important in understanding osteoarthritis and other bone diseases.Cite this article: M. Beverly, S. Mellon, J. A. Kennedy, D. W. Murray. Intraosseous pressure during loading and with vascular occlusion in an animal model. Bone Joint Res 2018;7:511–516. DOI: 10.1302/2046-3758.78.BJR-2017-0343.R2.

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Section: Discussionmentioning

confidence: 99%

Intraosseous pressure during loading and with vascular occlusion in an animal model

Beverly

Mellon

Kennedy

et al. 2018

Bone & Joint Research

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“…26 In the past, the intraosseous route was used only for emergency access, however it's now used in nonemergent situations in patients with limited or no vascular access. 27 If the patient's condition permits, the oral route should be considered for medication and fluid administration. It's preferable to avoid vascular access device placement when possible.…”

Section: Always Consider Local Policy and Consult With Team And Patie...mentioning

confidence: 99%

“…For instance, some hospitals have implemented successful midline catheter programs,24, 25 and for certain patients, the subcutaneous route is a safe alternative for hydration and some medications 26. In the past, the intraosseous route was used only for emergency access, however it's now used in nonemergent situations in patients with limited or no vascular access 27. If the patient's condition permits, the oral route should be considered for medication and fluid administration.…”

Section: ‘Idle’ Pivcs: Scope Of the Problemmentioning

confidence: 99%

CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management

Ray‐Barruel

2023

AJN, American Journal of Nursing

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Peripheral intravenous catheters (PIVCs) are among the most common invasive devices used in hospitalized patients, with over 300 million sold in the United States each year. However, about one-fourth of PIVCs are left in situ with no prescriber orders for iv medications or solutions, "just in case" they might be needed. PIVC insertion can be painful, is often unnecessary, and may increase a patient's risk of developing a bloodstream infection. This article reviews the evidence for the appropriate use of short PIVCs in hospitalized patients, assesses the ongoing need for PIVCs, provides recommendations for alternative options, and argues for promptly removing a PIVC that is no longer in use.

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“…Intra-osseous lines have already been adopted by many emergency medical services in the U.S. as well as the U.S. military [11][12][13][14][15]. IO infusion works through delivery of fluid to highly vascularized bone marrow, which is in turn drained by medullary venous channels and nutrient and emissary veins.…”

Section: Introductionmentioning

confidence: 99%

Design, Development, and Validation of an Intra-Osseous Needle Placement Guide

Slocum

Reinitz

Jariwala

et al. 2017

Journal of Medical Devices

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Intra-osseous (IO) needles are an easy and reliable alternative to intravenous (IV) access in the prehospital and emergency settings for treating patients in shock. The advantage of utilizing an IO is that secure, noncollapsible peripheral venous access can be obtained rapidly in critically ill patients. Placement of IO needles in the proximal tibia, humerus, or sternum, however, requires knowledge of human anatomy and the requisite skill to position, align, and place the device. In the developing world, this is not always available, and in the chaos of an in-hospital code, prehospital trauma, or a mass-casualty incident, even trained providers can have trouble correctly placing IV or IO needles. The Tib-Finder is an intuitive drill guide that significantly improves efficiency with which IO can be placed in the proximal tibia. Here, we present the conceptualization, design, and creation of an alpha-prototype Tib-Finder drill guide in less than 90 days; initial validation was achieved through analysis of anthropometric measurements of human skeletons, and usability studies were performed using untrained volunteers and mannequins. The Tib-Finder is intended to provide first responders and medical personnel, in the first world and the developing world, a way to accurately and repeatably locate the proximal tibia and achieve safe, rapid intravascular access in critically ill patients. Further, it eliminates the need for direct contact between patients and caregivers and improves the ease-of-use of IO devices by first responders and healthcare providers.

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Intraosseous vascular access in critically ill adults—a review of the literature

Abstract: The IO route is clearly a valuable alternative to problematic intravascular access. However, further research, including cost effectiveness reviews, is required to gain clarity of whole acute care approaches.

Cited by 18 publications

References 28 publications

Intraosseous pressure during loading and with vascular occlusion in an animal model

Intraosseous pressure during loading and with vascular occlusion in an animal model

CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management

Design, Development, and Validation of an Intra-Osseous Needle Placement Guide

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