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If you are unable to obtain IV access in a newborn or premie, would you hesitate to place an I/O? I've never done one in a newborn. Have their bones calcified enough to tolerate an I/O?
Pediatric I/O insertion
- Thread starter waterski232002
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When resuscitating a newborn I'd rather place an umbilical line. PALS (peds ACLS) is encouraging the IO when a pediatric patient needs resuscitation and a peripheral IV is unable to be placed. If you're in a code or near that point they support a 90 second window to place peripherals o/w start workin on your IO as it should be your immediate back-up for access (in this population). There are additional options as far as cut-downs and central access thereafter. Additionally the younger the child the easier it is to shatter the bone (not as hard as you may think). We've begun teaching IO insertion on both the standard chicken/turkey legs which you may have practiced on, but also on eggs, yes kids, eggs (and not hard boiled) - the shell strength more closely resembles the cortex of a younger childs tibia.
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So premies and newborns are not a contraindication to I/O placement?
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Clinical review: Vascular access for fluid infusion in children
Nikolaus A Haas
Critical Care 2004, 8:478-484 (3 June 2004)
Abstract
The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completly replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access.
Intraosseous infusions
Over the past two decades, the intraosseous (IO) route into the tibia has become a widely accepted procedure for the resuscitation of critically ill and injured children [84-88] such as trauma patients [89,90] and patients suffering from severe burns [91,92]. Newer devices, such as the 'bone injection gun', may increase the already widespread use of IO access [93,94].
The IO technique is included in standard protocols and training procedures [95,96], such as the Advanced Paediatric Life Support textbook, and it is recommended by the American Heart Association, the American Academy of Paediatrics, and the American College of Surgeons [97].
IO lines are not commonly used in newborn infants; however, it is recommended in neonates as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available [98-100]. Neonates were included in some series of IO therapy [101], but only few studies examined this route in neonates and premature infants [99,102]. Successful use in an 800 g baby has been reported [103]. Additionally, in a model of neonatal emergency vascular access, the IO route was found to be faster and easier than conventional umbilical venous catheterization [104].
Complications from the use of IO access occur rarely and include fractures and osteomyelitis after long-term use of IO access [105,106] or when hypertonic solutions have been used. Fat embolism is less likely in children than in adults and has minimal clinical consequences [107]. Local extravasation of fluids due to incomplete penetration of the needle into the cortex, IO infusion into a fractured limb, or perforation of the bone may lead to a compartment syndrome [108,109]. Finally, follow up in neonates ruled out concerns regarding injury to growing bone and the growth plate [110].
http://ccforum.com/content/8/6/478
Nikolaus A Haas
Critical Care 2004, 8:478-484 (3 June 2004)
Abstract
The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completly replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access.
Intraosseous infusions
Over the past two decades, the intraosseous (IO) route into the tibia has become a widely accepted procedure for the resuscitation of critically ill and injured children [84-88] such as trauma patients [89,90] and patients suffering from severe burns [91,92]. Newer devices, such as the 'bone injection gun', may increase the already widespread use of IO access [93,94].
The IO technique is included in standard protocols and training procedures [95,96], such as the Advanced Paediatric Life Support textbook, and it is recommended by the American Heart Association, the American Academy of Paediatrics, and the American College of Surgeons [97].
IO lines are not commonly used in newborn infants; however, it is recommended in neonates as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available [98-100]. Neonates were included in some series of IO therapy [101], but only few studies examined this route in neonates and premature infants [99,102]. Successful use in an 800 g baby has been reported [103]. Additionally, in a model of neonatal emergency vascular access, the IO route was found to be faster and easier than conventional umbilical venous catheterization [104].
Complications from the use of IO access occur rarely and include fractures and osteomyelitis after long-term use of IO access [105,106] or when hypertonic solutions have been used. Fat embolism is less likely in children than in adults and has minimal clinical consequences [107]. Local extravasation of fluids due to incomplete penetration of the needle into the cortex, IO infusion into a fractured limb, or perforation of the bone may lead to a compartment syndrome [108,109]. Finally, follow up in neonates ruled out concerns regarding injury to growing bone and the growth plate [110].
http://ccforum.com/content/8/6/478
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Thanks... that's just what I was looking for! This is why I love this forum 😉
