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When should intraosseous access be considered a first-line option?

IO

“In cases in which there is an urgent need for medications and fluid resuscitation, whether in infants, children, or adults, and immediate intravenous access is not easily obtainable, intraosseous access should be considered as a first-line option” DeBoer et al (2020).

Overview of intraosseous vascular access

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“Intraosseous (IO) vascular access refers to the placement of a specialized hollow bore needle through the cortex of a bone, into the medullary space for infusion of medical therapy and laboratory tests” Dornhofer and Kellar (2020).

Intraosseous access sites in rabbits

fda iv pump error

“The study goals were to determine if intraosseous (IO) catheters can be placed with greater success into the humerus, femur, or tibia of cadaver rabbits, and to evaluate the accuracy of perceived success (PS) and objective clinical success (OCS) criteria against true intramedullary catheterization confirmed by fluoroscopy” Kennedy et al (2020).

Intraosseous access in adults in cardiac arrest

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“To evaluate the efficacy of intraosseous access versus venous access in out-of-hospital cardiac arrest in terms of return of spontaneous circulation (ROSC) and survival to hospital discharge with or without favorable neurologic status” Morales-Cané et al (2020).

Survival after intravenous versus intraosseous Amiodarone

intraosseous infusion sites

Survival to hospital admission also increased significantly when drugs were given IV but not IO, and favored improved neurological outcome at discharge” Daya et al (2020). Abstract: Background: Antiarrhythmic drugs have not proven to significantly improve overall survival after out-of-hospital cardiac arrest (OHCA) from shock-refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). How this might be influenced […]

Propionibacterium acnes osteomyelitis after intraosseous cannulation

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We report here an extremely rare incident of P. acnes tibial osteomyelitis at the IO access site” Cole et al (2019). Abstract: Propionibacterium acnes osteomyelitis secondary to intraosseous (IO) cannulation is not well documented in literature. We report here an extremely rare incident of P. acnes tibial osteomyelitis at the IO access site, in a […]

Are intraosseous infusion needles long enough for children?

IO

The EZ-IO intraosseous (IO) needle is available in 2 needle sizes for children based on the patient weight. To date, there is no published evidence validating the use of weight-based scaling in children. We hypothesized that pretibial subcutaneous tissue thickness (PSTT) does not correspond with patient weight but rather with age and body mass index […]

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