Semi‐elective intraosseous infusion after failed intravenous access in pediatric anesthesia¹

Abstract

IO access represents a quick and reliable alternative for pediatric patients with prolonged difficult or failed IV access after inhalational induction of anesthesia.

Evaluation of a new pediatric intraosseous needle insertion device for low-resource settings

“…Studies have demonstrated that IO use can decrease the time needed to obtain vascular access in pediatric patients in cardiac arrest [6,8] and that the success of vascular access in this patient population is higher for IO access (83%) than for saphenous venous cutdown (81%), subclavian central line (77%), and percutaneous peripheral (17%) [9]. Although typically used in the emergency and critical care settings, IO access can also be used in the perioperative setting [10]. Historically, IO use was recommended only in children younger than 6 years; however, its use in infants, pediatric, and adult patients has been supported by recent literature, as well as guidelines for cardiopulmonary resuscitation and trauma [11][12][13].…”

Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Health Care Settings

“…Intraosseous access can be considered clinically appropriate on the basis of a shortterm need for patients • with chronic disease who have been admitted to the hospital for treatment of a medical event, for example, the deteriorating patient with chronic obstructive pulmonary disease; • with limited vascular access due to aggressive treatment modalities, for example, fistulas, grafts, shunts, mastectomies, or multiple central catheter placements; • for whom Rapid Response Teams are called to prevent an emergent situation and in whom obtaining peripheral or central IV access is difficult; • who experience an unexpected medical event that causes their peripheral or central IV device to become nonfunctional, for example, infiltration or occlusion, and difficult to reestablish; • who have limited peripheral access due to morbid obesity; • who suffer from intractable pain; • who are in the early stages of sepsis; • who are receiving palliative or hospice care; • who are undergoing anesthesia and experience prolonged, difficult, or failed IV access. 26,27 …”

Intraosseous infusion in elective and emergency pediatric anesthesia

“…Therefore, there are more and more case reports and recommendations for its use not only in the prehospital emergency situation but also for perioperative pediatric anesthesia care [14,22,29,31,32,34,[39][40][41][42][43][44][45][46]. As a consequence of these reports and in order to provide a structured approach, the German Scientific Working Group for Pediatric Anesthesia published working guidelines in 2011 for the use of intraosseous infusion in the pediatric perioperative setting [37].…”