TRIPASS XR تري باس

 

363

Mary E. Revenis

Lamia Soghier

50 Intraosseous Infusions

A. Indications

1. Emergency IV access when other venous access is not

readily available; to restore intravascular volume so that

peripheral venous access becomes possible. See Table

50.1 for categories of fluid and medications that have

been infused (1–6).

B. Contraindications (3,5,6)

1. Bone without cortical integrity (fracture, previous penetration): Extravasation of infusate

2. Sternal site: Potential damage to heart and lungs (7)

3. Overlying soft tissue infection

4. Osteogenesis imperfecta

5. Obliterative diseases of marrow such as osteopetrosis

C. Equipment (Fig. 50.1)

Sterile

1. Surgical gloves

2. Antiseptic swabs

3. Gauze squares

4. Aperture drape

5. 1% lidocaine in 1-mL syringe with a 25-gauge needle

6. Needle, in order of preference (1–3,10)

a. Bone marrow or intraosseous needle (18-gauge)

(stylet and adjustable depth indicator preferred)

b. Short spinal needle with stylet (18- or 20-gauge)

c. Short hypodermic needle (18- or 20-gauge)

d. Butterfly needle (16- to 19-gauge) (8)

7. 5-mL syringe on a three-way stopcock and IV extension

set with clamp

8. IV-infusion set and IV fluid

9. 5-mL syringes with saline flush solution

Optional

Intraosseous needle placement device (intended for use at

the proximal tibial location). Devices approved for newborns

are the battery operated driver EZ-IO PD (Pediatric) (Vidacare,

San Antonio, Texas) (approved for 3 kg or larger), and the

spring-activated B.I.G. Bone Injection Gun (WaisMed,

Houston, Texas). There are company-provided reports of use

in delivery rooms and intensive care nurseries. Published information on use of these devices in small premature infants is

scarce. There is limited information on the incidence of success or complications when using these devices, as compared

with manual insertion of the intraosseous needle (9).

Nonsterile

1. Small sand bag or rolled towel to aid in stabilizing limb

2. Tape

3. Armboard

4. Disposable plastic cup

D. Precautions

1. Limit use to emergency vascular access, when peripheral or central venous access is not feasible (11).

2. Avoid inserting needle through infected skin or subcutaneous tissue.

3. Stabilize limb with counterpressure, with sand bag or

towel roll directly opposite proposed site of penetration,

to avoid bone fracture.

4. If hand is also used to stabilize limb, do not position

hand directly opposite puncture site, to avoid inadvertent puncture of hand by the intraosseous needle if it

goes through the limb. This is true regardless of whether

a sand bag or towel is used. Limit needle size to decrease

risk of bone fracture.

5. Administer drugs in the usual doses for IV administration; however, when possible, to reduce the risk of bone

marrow damage, dilute hypertonic or strongly alkaline

solutions prior to infusion (2).

6. Discontinue intraosseous infusion as soon as alternative

venous access is established, to reduce risk of osteomyelitis.

E. Technique

Proximal Tibia (1–3,12) (Fig. 50.2)

1. Position patient supine.

2. Place sand bag or towel roll behind knee to provide

countersupport behind puncture site.