A life-saving line in resuscitation and shock management of the critically ill child: intraosseous infusion

Abstract

Intensive Care Unit, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara Aim: Intraosseous infusion (IOI) is an alternative method of vascular access which is considered when peripheral intravenous line cannot be achieved rapidly. Epinephrine, adenosine, crystalloids, colloids and blood products can be administered effectively using this route during resuscitation and shock management. Material and Methods: We retrospectively evaluated the medical records of Pediatric Intensive Care Unit (PICU) patients who had required IOI administration, and the complications of this method are searched. Results: Medical records of 332 patients who had been followed in our PICU were examined and 13 patients (3.9%) were detected to have IOI administered. Our patients’ median age was 8 months, and male:female ratio was 2,5. The primary diagnoses of our IOI administered patients were septic shock (6), cardiogenic shock (2), acute gastroenteritis (1), hemorrhagic shock and encephalopathy syndrome (4). IOI were performed 2 of 13 patients during resuscitation. We performed IOI by spinal needle in 10 (76.9%) patients and by bone marrow aspiration needle in three patients. Eight (61.64%) patients were inpatient. The sites for placement of IO line were right proximal tibia in 12 patients, left proximal tibia in 2 patients, and right distal femur in one patient. The median time of IOI was 20 hours (3 hours-9 days) , and 11 patients survived in the first 24 hours. The only complication was extravasation, seen in a patient. Conclusion: IOI is indicated in life-threatening situations in which vascular access is essential for treatment, and should be kept in mind for being an easily achieved vascular access.