Preferred anatomic site for intraosseous infusion in Danish emergency departments

Molin, Rune; Hallas, Peter; Brabrand, Mikkel; Schmidt, Thomas A.

doi:10.1186/1757-7241-18-s1-p26

Cited by 4 publications

(4 citation statements)

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“…Obtaining IO access may be done with a variety of devices at numerous anatomical sites with the tibia and humerus being the most commonly accessed. 75,76 Appropriate insertion of IO access may still be complicated by convulsions, but offers the advantage of the ability to obtain certain laboratory studies as well as continued access for subsequent medication administration if required. IO access should not be attempted in a fractured bone, and if the initial attempt to obtain access is unsuccessful, an attempt at that particular site should not be made again until at least 12 hours later.…”

Section: Intraosseousmentioning

confidence: 99%

Principles of Pharmacotherapy of Seizures and Status Epilepticus

2020

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Status epilepticus is a neurological emergency with an outcome that is highly associated with the initial pharmacotherapy management that must be administered in a timely fashion. Beyond first-line therapy of status epilepticus, treatment is not guided by robust evidence. Optimal pharmacotherapy selection for individual patients is essential in the management of seizures and status epilepticus with careful evaluation of pharmacokinetic and pharmacodynamic factors. With the addition of newer antiseizure agents to the market, understanding their role in the management of status epilepticus is critical. Etiology-guided therapy should be considered in certain patients with drug-induced seizures, alcohol withdrawal, or autoimmune encephalitis. Some patient populations warrant special consideration, such as pediatric, pregnant, elderly, and the critically ill. Seizure prophylaxis is indicated in select patients with acute neurological injury and should be limited to the acute postinjury period.

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Section: Intraosseousmentioning

confidence: 99%

Principles of Pharmacotherapy of Seizures and Status Epilepticus

2020

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“…First described in 1940, the proximal tibia remains the most popular site for IO needle insertion, both in children and in adults (Tocantins, 1940; Tocantins and O’Neill, 1940; Molin et al, 2010). In fact, one recent study reported that 84% of providers preferred the proximal tibial site over the humerus (10%) or the distal tibia (10%) (Molin et al, 2010). The conventional bias against proximal tibial infusion in adults seems to have originated with Tocantins in 1945, for anatomic reasons.…”

Section: Insertion Sitesmentioning

confidence: 99%

Intraosseous vascular access: A review

Paxton

2012

Trauma

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Intraosseous cannulation is an increasingly common means of achieving vascular access for the administration of fluids and medications during the emergent resuscitation of both paediatric and adult patients. Improved tools and techniques for intraosseous vascular access have recently been developed, enabling the healthcare provider to choose from a wide range of devices and insertion sites. Despite its increasing popularity within the adult population, and decades of use in the paediatric population, questions remain regarding the safety and efficacy of intraosseous infusion. Although various potential complications of intraosseous cannulation have been theorized, few serious complications have been reported. This article aims to provide a review of the current literature on intraosseous vascular access, including discussion on the various intraosseous devices currently available in the market, the advantages and disadvantages of intraosseous access compared to conventional vascular access methods, complications of intraosseous cannulation and current recommendations on the use of this approach.

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“… 5 In adults, the most commonly used insertion sites are the proximal and distal tibia, and the proximal humerus. 6 …”

Section: Introductionmentioning

confidence: 99%

“…5 In adults, the most commonly used insertion sites are the proximal and distal tibia, and the proximal humerus. 6 The overall complication rate is low 3,7 but misplacement may have serious consequences. 8 The most common complication is extravasation of drugs and fluids, which may result in ineffective treatment and compartment syndrome requiring fasciotomy or limb amputation.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in appropriate insertion depth for intraosseous access in adults: An exploratory radiologic single-center study

Miller¹,

Nardelli

Hell

et al. 2022

J Vasc Access

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Background: Intraosseous access is a recommended alternative to venous access in emergencies. For its application, knowledge of the correct insertion depth is indispensable. We aimed to determine sex-specific differences on the appropriate insertion depth for intraosseous access in adults at the insertion sites most frequently used, namely the proximal and distal tibia and the proximal humerus. Methods: In this exploratory retrospective study, we measured thickness of soft tissue cover, cortex and cancellous bone along the puncture line on magnetic resonance images or computed tomography scans. Inclusion criteria were both sexes, 18–90 years of age and appropriate image quality. Primary outcome was the appropriate insertion depth to reach the cancellous bone for each sex. This was defined as the corridor between (i) the sum of the soft tissue cover and the cortex and (ii) the sum of (i) plus the diameter of the cancellous bone. Secondary outcomes were the differences in thickness of each layer between sexes. Results: In 179 females and males, the appropriate insertion depth was 32.5–45.5 mm and 20.5–42.0 mm in the proximal tibia, 14.5–30.5 mm and 16.5–34.5 mm in the distal tibia, and 27.5–52.5 mm and 26.0–56.5 mm in the proximal humerus. Although females had a thicker soft tissue cover (+6.8 mm [95% CI 3.7–10.1], p < 0.01) in the proximal tibia, extrapolation by correlation analysis showed no clinically relevant difference between the sexes. Conclusion: In adults, there are no sex-specific differences in the appropriate insertion depth for intraosseous access in the proximal or distal tibia or in the proximal humerus.

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Preferred anatomic site for intraosseous infusion in Danish emergency departments

Cited by 4 publications

References 0 publications

Principles of Pharmacotherapy of Seizures and Status Epilepticus

Principles of Pharmacotherapy of Seizures and Status Epilepticus

Intraosseous vascular access: A review

Sex differences in appropriate insertion depth for intraosseous access in adults: An exploratory radiologic single-center study

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