Page 11 - American Nurse Today January 2008

Strictly Clinical —
Now, intraosseous infusions for adults
By Kyle Madigan, RN, CFRN, CCRN, CEN
WHEN YOUR PATIENT needs I.V.
fluids or drugs stat but I.V. access
isn’t an option, the intraosseous
(IO) route may be. At one time,
IO administration was almost ex-
clusively a pediatric procedure, in part because the outer layer of pediatric bone is more cartilaginous and easier to penetrate than the dense outer layer of adult bone. But today, because of advances in technology, IO administration is safe and efficient for adults, too. (See Intraosseous access makes a comeback.)
Into the marrow
Composed of a spongy network rich in blood vessels, nerves, and fat tissue, the marrow cavity in long bones can act as a noncollapsible
vein during IO infusion. When emer-
gency drugs, blood products, or flu- ids are administered, the highly vas- cular IO bed absorbs them into the peripheral circulation.
The IO route is indicated for pa- tients needing an immediate infusion when I.V. access would be delayed or is impossible. The universal con- traindication for IO access is a frac- ture of the bone at or above the in- sertion site. Relative contraindications include osteogenesis imperfecta, os- teoporosis, previous knee-replace- ment surgery, and infected tissue at the insertion site. The efficacy of IO access through burned tissue has been debated, but a recent case re- port demonstrates the successful use of a sternal IO catheter in the cardiac resuscitation of a patient with full- thickness burns.
Placing an IO catheter
The most common insertion site is the anterior proxi- mal tibia, below and medial to the tibial tuberosity, where the tibia is flat and wide. Alternative sites, such as the proximal humerus and the manubrium, can al- so be used.
Preparing for IO needle inser- tion is similar to preparing for I.V. needle insertion. Use an antisep- tic solution, such as chlorhexidine gluconate (Chloraprep), to prep
the skin. You may use 1% lidocaine to anesthetize the skin, subcutaneous tissue, and the periosteum. The in- sertion does cause pain, but it’s not as painful as it looks. Most patients rate the pain as a 2 or 3 on a scale of 1 to 10.
The needle traditionally used for IO insertion has been a bone aspiration needle with a trocar that pre- vents the needle from becoming plugged with bone. Today, you can use one of four types of devices:
• manual-insertion devices, such as the Jamshidi and
When I.V. access is out, intraosseous infusion can get drugs and fluids in.
Intraosseous access makes a comeback
During World War II, when I.V. ac- cess was delayed or impossible for soldiers in shock, intraosseous (IO) cannulas were used to deliver flu- ids and drugs. With the develop- ment of the plastic I.V. catheter af- ter the war, the use of IO access rapidly declined.
Then, in 1988, the American Heart Association (AHA) recom- mended IO access in its Pediatric Advanced Life Support standards. In 2003, the AHA extended the recommendation to adults in the “Guidelines for Cardiopulmonary Resuscitation and Emergency Car- diovascular Care,” going so far as to say that IO and I.V. access should be attempted simultaneously.
the Sussmane-Raszynski, which have handles that allow you to rotate and push the needle into the bone simultaneously
• impact, spring-powered devices, such as the bone injection gun, which inserts the needle when you
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