Ideal intraosseous insertion site in neonates
Abstract:
Purpose: Methods to administer intramedullary medication and fluid infusion in both adults and children date to the early twentieth century. Studies have shown that intraosseous access in the proximal tibia is ideal for resuscitation efforts as fewer critical structures are at risk, and neither is the blood flow to the lower limbs compromised. Insertion of a needle in children younger than 5 years does have the risk to damage to the epiphyseal growth plate. Therefore, the aim of this study was to determine the ideal intraosseous insertion site distal to the epiphyseal growth plate in neonates.
Methods: The samples consisted of both the left and right sides of 15 formalin-fixed neonatal cadavers. The dimensions were measured on the superior surfaces of each section, anteromedial border, cortical thickness, and medullary space.
Results: The most desirable location to gain vascular access is at 10 mm inferior to the tibial tuberosity.
Conclusion: The smallest cortical thickness (1.32 mm), the largest medullary space (4.50 mm), and the largest anteromedial surface (7.72 mm) were observed at 10 mm inferior to the tibial tuberosity. It is imperative that health care professionals are familiar with the osteological sites that could be safely used for an intraosseous infusion procedure.
Reference:
van Tonder DJ, van Niekerk ML, van Schoor A. Proximal tibial dimensions in a formalin-fixed neonatal cadaver sample: an intraosseous infusion approach. Surg Radiol Anat. 2021 Nov 29. doi: 10.1007/s00276-021-02843-1. Epub ahead of print. PMID: 34845509.