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Abstract

Intraosseous infusions are used in children when intravenous access is difficult or impossible. The intraosseous route is also applicable to adults, but is not widely used. In this article, the anatomy and physiology of bone marrow is described and techniques and sites of intraosseous needle placement are discussed. Fluid and drug administration by the intraosseous route is also discussed. Intraosseous anaeasthesia and diagnostic testing is possible through intraossoeous needles. Potential complications and contraindications are considered.

Keywords

intraosseous infusions bone marrow fluid and drug therapy Halvorson device diagnostic testing

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References

Bang O. 1942. Den intraossose infusion. Ugeskr Laeger 104: 1523-1524.

Bell MC. 1991. Intraosseous transfusion in an anaesthetized swine model using 51Cr-labelled autologous red cells. J Trauma 31: 11 1487-11 1489.

Berg RA. 1984. Emergency infusion of catecholamines into the bone marrow. Am J Dis Childhood 138: 810-811.

Biello JF , O’Hair KC , Kriby WC et al. 1991. Intraosseous infusion of dobutamine and isoproterenol. Am J Dis Childhood 145: 165-167.

Brickman KR. 1987. A comparative study of intraosseous versus peripheral intravenous infusion of diazepam and phenobarbital in dogs. Ann Emerg Med 16: 83-86.

Cameron JL , Fontanarosa PB , Passalaqua AM. 1989. A comparative study of peripheral to central circulation delivery times between intraosseous and intravenous injection using a radionuclide technique in normovolaemic and hypovolaemic canines. J Emerg Med 7: 123-127.

Cilley RE. 1992. Intraosseous infusion in infants and children. Semin Paediatr Surg 1: 202-207.

Doud EH Tysell JE. 1942. Massive intramedullary infusions. J Am Med Assoc 120: 1212-1213.

Drinker CK , Drinker KR , Lund CC. 1922. The circulation in the mammalian bone marrow. Am J Physiol 62: 1-92.

10.

Friedman FD. 1996. Intraosseous adenosine for the termination of supraventricular tachycardia in an infant. Ann Emerg Med 28: 356-359.

11.

Getschman SJ , Dietrich AM , Franklin WH , Allen HD. 1994. Intraosseous adenosine. Arch Pediatr Adolesc Med 148: 616-619.

12.

Glaeser PW , Hellmich TR , Szewczuga D et al. 1993. Five years’ experience in prehospital intraosseous infusions in children and adults. Ann Emerg Med 22: 1119-1124.

13.

Guy J , Haley K , Zuspan SJ. 1993. Use of intraosseous infusion in the paediatric trauma patient. J Ped Surg 158-161.

14.

Halvorson L. 1990. Evaluation of an intraosseous infusion device for the resuscitation of hypovolaemic shock. J Trauma 30: 652-658.

15.

Heinild S , Sondergaard T , Tudvad F. 1947. Bone marrow infusions in childhood: experiences from a thousand infusions. J Ped 30: 400-411.

16.

Hurren JS , Dunn KW. 1995. Intraosseous infusion for burns resuscitation. Burns 21: 285-287.

17.

Iserson KV. 1989. Intraosseous infusions in adults. J Emerg Med 7: 587-591.

18.

Iserson KV , Criss E. 1986. Intraosseous infusions: a usable technique. Am J Emerg Med 4: 540-542.

19.

Iwama H. 1994. Clavicular approach to intraosseous infusion in adults. Fukushima J Med Sci 40: 1-8.

20.

Iwama H , Katsumi A. 1996. Clavicular intraosseous access. J Trauma 41: 931-932.

21.

Jim KF et al. 1989. Supression of pentylentetrazol-elicited seizure activity by intraosseous lorazepam in pigs. Epilepsia 30: 480-486.

22.

Josefson A. 1934. A new method of treatment - intraossal injections. Acta Med Scand 81: 550-564.

23.

Katan BS , Olshacker JS , Dickerson SE. 1988. Intraosseous infusion of muscle relaxants. Am J Emerg Med 6: 353-354.

24.

Kiaer T. 1990. Effects of variation in systemic blood pressure on intraosseous pressure pO2 and pCO2. J Orth Res 8: 618-622.

25.

LaSpada J. 1995. Extravasation rates and complications of intraosseous needles during gravity and pressure infusion. Crit Care Med 23: 2023-2028.

26.

Macht DI. 1941. Absorption of drugs through the bone marrow. Proc Soc Exp Biol Med 47: 299-302.

27.

Meola F. 1944. Bone marrow infusion as a routine procedure in children. J Pediatr 25: 13-13.

28.

McNamara RM , Spivey WH , Unger HD , Malone DR. 1987. Emergency applications of intraosseous infusions. J Emerg Med 5: 97-101.

29.

Mofenson, HC , Tascone A , Caraccio TR. 1988. Guidelines for intraosseous infusions. J Emerg Med 6: 143-146.

30.

Neish SR , Macon MG , Moore JW et al. 1988. Intraosseous infusion of hypertonic glucose and dopamine. Am J Dis Child 142: 878-880.

31.

Orlowski JP. 1989. The bone marrow as a source of laboratory studies. Ann Emerg Med 18: 1348-1351.

32.

Orlowski JP. 1990. Comparison study of intraosseous, central intravenous and peripheral infusions of emergency drugs. Am J Dis Childhood 144: 112-117.

33.

Perron PR , Gunther RA , Kramer GC. 1988. Pressure-flow relationships of intraosseous infusions. Circ Shock 24: 282-282.

34.

Pillar S. 1954. Re-emphasis on bone marrow as a medium for administration of fluid. New Engl J Med 18: 846-851.

35.

Plewa MC. 1995. Hematologic safety of intraosseous blood transfusion in a swine model of pediatric hemorrhagic hypovolaemia. Acad Emerg Med 2: 799-809.

36.

Prete MR , Hannan CJ , Burkle FM. 1986. Plasma atropine concentrations via the intravenous endotracheal and intraosseous routes of administration. Ann Emerg Med 15: 195-195.

37.

Rosetti VA , Thompson BM , Miller J , Mateer JR et al. 1985. Intraosseous infusion: an alternative route of paediatric intravascular access. Ann Emerg Med 14: 885-887.

38.

Saavedra J , Patterson HA , Kramer GC. 1988. Intraosseous injection of hypertonic saline dextran: anatomic considerations. Circ Shock 24: 283-283.

39.

Schoffstall JM. 1989. Intraosseous crystalloid and blood infusion in a swine model. J Trauma 29: 384-387.

40.

Selby IR , James MR. 1993. The intraosseous route for induction of anaesthesia. Anaesthesia 48: 982-984.

41.

Sheikh AA. 1996. Intraosseous resuscitation of hemorrhagic shock in a pediatric animal model using a low sodium hypertonic fluid. Crit Care Med 24: 1054-1061.

42.

Shoor MP , Berryhill RE , Benmof JL. 1979. Intraosseous infusion: pressure-flow relationship and pharmacokinetics. J Trauma 19: 772-774.

43.

Smith RJ , Kosey DP , Menley LK et al. 1988. Intraosseous infusions by prehospital personnel in critically ill paediatric patients. Ann Emerg Med 17: 97-101.

44.

Spivey WH. 1985. Comparison of intraosseous, central and peripheral routes of sodium bicarbonate administration during CPR in pigs. Ann Emerg Med 14: 19-24.

45.

Strausbaugh SD. 1995. Circumferential pressure as a rapid method to assess intraosseous needle placement. Ped Emerg Care 11: 274-276.

46.

Tarrow AB. 1952. Infusions via the bone marrow and biopsy of the bone and bone marrow. Anesthesiol 13: 501-509.

47.

Thomas ML , Tighe JR. 1973. Death from fate embolism as a complication of intraosseous phlebography. Lancet 1415-1416.

48.

Tocantins LM. 1940. Rapid absorption of substances injected into the bone marrow. Proc Soc Exp Biol Med 45: 292-296.

49.

Tocantins LM , O’Neill JF. 1941. Infusions of blood and other fluids into the general circulation via the bone marrow. Surg Gynecol Obst 73: 281-287.

50.

Tocantins LM , O’Neill JF. 1945. Complications of intraosseous therapy. Ann Surg 122: 266-277.

51.

Turkel H. 1984. Emergency infusion through the bone. Mil Med 149: 349-350.

52.

Valdes MM. 1977. Intraosseous fluid administration in emergencies. Lancet 1235-1236.

53.

Velasco AL. 1991. Intraosseous infusion of fluids in the initial management of hypovolaemic shock in young subjects. J Ped Surg 26: 4-8.

54.

Vaughan JM. 1943. The transfusion of blood and blood derivatives under emergency conditions. JAMA 13: 1020-1025.

55.

Waisman M. 1995. Intraosseous regional anesthesia as an alternative to intravenous regional anaesthesia. J Trauma 39: 1153-1156.

56.

Waisman M , Waisman D. 1997. Bone marrow infusion in adults. J Trauma 42: 288-293.

57.

Young AE. 1973. Fat embolism after pertrochanteric venography. BMJ 4: 592-592.

58.

Zimmerman JJ , Coyne M , Logsdon M. 1989. Implementation of intraosseous infusion technique by aeromedical transport programs. J Trauma 29: 687-689.

Intraosseous infusions in the adult

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