Intraosseous cannulation

Abstract

Intraosseous cannulation is the technique of choice for vascular access in children during resuscitation and is indicated in an emergency when conventional access cannot be obtained rapidly. Although often advised in those younger than 6 years of age, it is actually useful throughout childhood. The proximal tibia is the commonest site of insertion. Complications are infrequent, but include extravasation, dislodgement and local infection. All drugs and fluids indicated in a sick child can be given, but as flow rates for gravity-driven infusions are low, drugs should be infused under pressure or ‘flushed in’ with saline. During the early stages of resuscitation, most biochemical variables (U&Es, acid-base) are similar to mixed venous values. Marrow samples poorly predict venous platelet concentrations and [Hob] values are consistently lower. However, they can be used to group and cross match blood for transfusion.