We’re back with all new Morning Report’s this week. Today’s is a review of IO access courtesy of Dr. Guy, so check it out!
Intraosseous Vascular Access
History
Sweden 1922
World war II 1944
1980 used in India for cholera epidemic
1988 PALS
Anatomy
Nutrient artery-ascending and descending artery-arterioles- capillaries- central venous canal- medullary sinus accept fluids
Infusion
possible to infuse at a rate up to 45ml/min
sternum if elderly as long bone vascular system become fatty
Children less than 6- proximal tibia
Adults- distal tibia
Sternum advantaged- large, easy to penetrate, less fatty infiltration
Needle Insertion
Manual needle insertion
Perpendicular to surface
Twist with pressure
Penetration 1 cm or less
Aspiration of blood and secure
FAST 1- sternum
BIG
EZ-IO
Drill
15gauge 25mm needle for heavier than 40kg
15 gauge 15mm less than 39kg
Complications
Most commonly penetrating posterior cortex- pull back
Clogged catheter- flush
Infection- sugar infusion (0.6-3%)
Extravasations
Compartment syndrome
Thanks Dr. Guy! Leave any comments below.
Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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