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More Intraosseous Infusion stuff

Keith trauma-list@trauma.org
Sat, 11 Jan 2003 14:36:14 -0500 

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      >>>>Over the last week I have been watching the comments flying =
about adult intraosseous devices, there administration and how barbaric =
they are to the patient.  Up front I am going to state that I am the =
Director of Sales for a national EMS distributor.  My purpose here is =
not to promote a product, but to let you know that most products for =
adult intraosseous fluid
      administration are barbaric due to the way they are applied, the =
needles bending etc.  A new product was released in the US about a year =
ago that is SIMPLE, EASY, LESS PAINFUL TO THE PATIENT THAN AN IV and =
inexpensive.<<<<


      Bill DeMars RRT/BS

      Bill.....


      Not sure that the BIG point of this discussion has been =
pain..discomfort of the patient but rather that the whole pre-hospital =
hyper resuscitation "tryin to get normotension" concept has in and of =
itself been disproved....thereby making it VERY difficult to prove the =
need and or efficacy of intra osseous infusion. I checked out the =
website that you mentioned. If nothing else there is an interesting =
explanation of how IO infusion is supposed to work. I have included it =
below for those interested.

      Keith


      Keith D. Lamb RCP, RRT
      Team Leader/Charge Therapist
      Christiana Care Health Services
      Newark, Delaware


      As we all know, bones are living, functioning organs, just like =
the other organs of the body. Bones require oxygen and glucose in order =
to produce energy and the metabolic products (red blood cells, =
endogenous factors of the immune system, etc.) unique to this system. =
The supply of oxygen and glucose is derived through blood vessels, which =
are distributed from the hard structure of the bone cortex through the =
softer skeletal centers. In each of the long bones (tibia, femur) there =
are a number of openings through which arteries enter the bone, as well =
as a number of openings where veins exit the bone, which serve to drain =
the blood back into the vascular system. Most of these openings are =
concentrated in the area called the Epiphysis, located in the upper part =
or endpoint of the bone (the joint area). Another feature of the =
Epiphysis is that the cortex tissue in this area is usually thinner than =
in the main part of the bone.=20

      The structure of the bone cortex is interesting unto itself, being =
composed of a series of transport blood vessels called the Haversian =
canal system, situated in tubular centers called Minerlized Matrix which =
make up most of the hard cortex, and the Volkman canal system, which =
crosses through those tubular centers. Looking even deeper inside the =
space within the bone, we find a system of tubes called the Trabecular =
space.=20
      This system is too complex for a simple explanation, but it is =
important to note that it diffuses dissolved materials in the blood, and =
performs osmosis on larger volumes of fluid to accommodate the system of =
blood vessels that enter and exit the bone.


      =20


    =20
       =20
      The fundamental principle behind any Intraosseous technique is =
based on this unique complex of blood vessels. A system that penetrates =
into the Trabecular space and introduces liquids at a positive pressure =
will cause increased diffusion "with the current" and in fact pass on =
quantities of water into the blood system, which drain the Trabecular =
cavities.=20

      In simple terms, we are introducing material into a filtering =
system with adaptable permeability.

      Why the adaptable permeability? For the simple reason that, as the =
pressure of the flow into the system increases, the molecules that make =
up the cell membranes of the Trabecular canals, the Haverisan canals and =
the Volkman canals expand, causing larger drainage spaces for =
permeability. The result, naturally, is a higher flow volume.=20

      Once the introduction of fluid at high pressure is stopped, the =
system immediately returns to its original size, and will continue to =
enable transmission of fluids, although at a slower rate, as long as the =
external pressure created by the fluid is higher than the pressure =
inside the bone.

      These two configurations enable the healthcare provider to supply =
the rate of flow according to the patient's condition. For example, a =
patient requiring medication through a drip counter will not need a =
high-pressure flow. However, a patient who is in hypovolemic shock can =
receive the necessary quantities of fluids through high-pressure =
infusion.
      This short overview can be summarized by the importance of the =
channeled structure of the bone interior through which accelerated =
diffusion allows fluids and medications to be introduced into the blood =
system.=20




    =20






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      <P><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2><FONT=20
      face=3D"Comic Sans MS" size=3D2></FONT></FONT>&nbsp;</P>
      <P><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2><FONT=20
      face=3D"Times New Roman" size=3D3>&gt;&gt;&gt;&gt;Over the last =
week I have=20
      been watching the comments flying about adult intraosseous =
devices, there=20
      administration and how barbaric they are to the patient.&nbsp; Up =
front I=20
      am going to state that I am the Director of Sales for a national =
EMS=20
      distributor.&nbsp; My purpose here is not to promote a product, =
but to let=20
      you know that most products for adult intraosseous =
fluid<BR>administration=20
      are barbaric due to the way they are applied, the needles bending=20
      etc.&nbsp; A new product was released in the US about a year ago =
that is=20
      SIMPLE, EASY, LESS PAINFUL TO THE PATIENT THAN AN IV and=20
      inexpensive.&lt;&lt;&lt;&lt;</FONT></FONT></P><FONT face=3D"Comic =
Sans MS"=20
      color=3D#000000 size=3D2><FONT face=3D"Times New Roman" size=3D3>
      <P><BR><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2><FONT =

      face=3D"Times New Roman" size=3D3>Bill DeMars=20
      RRT/BS</FONT><BR></FONT><BR><FONT face=3D"Comic Sans MS"=20
      size=3D2>Bill.....</FONT></P>
      <DIV><FONT face=3D"Comic Sans MS" size=3D2></FONT>&nbsp;</DIV>
      <DIV><FONT face=3D"Comic Sans MS" size=3D2>Not sure that the BIG =
point of this=20
      discussion has been pain..discomfort of the patient but rather =
that the=20
      whole pre-hospital hyper resuscitation "tryin to get normotension" =
concept=20
      has in and of itself been disproved....thereby making it VERY =
difficult to=20
      prove the need and or efficacy of intra osseous infusion. I =
checked out=20
      the website that you mentioned. If nothing else there is an =
interesting=20
      explanation of how IO infusion is supposed to work. I have =
included it=20
      below for those interested.</FONT></DIV>
      <DIV><FONT face=3D"Comic Sans MS" size=3D2></FONT>&nbsp;</DIV>
      <DIV><FONT face=3D"Comic Sans MS" size=3D2>Keith</FONT></DIV>
      <DIV><FONT face=3D"Comic Sans MS" size=3D2></FONT>&nbsp;</DIV>
      <DIV><FONT face=3D"Comic Sans MS" size=3D2></FONT>&nbsp;</DIV>
      <DIV><FONT face=3D"Comic Sans MS" size=3D2>Keith D. Lamb RCP, =
RRT<BR>Team=20
      Leader/Charge Therapist<BR>Christiana Care Health =
Services<BR>Newark,=20
      Delaware</FONT></DIV>
      <P><FONT face=3D"Comic Sans MS" =
size=3D2></FONT></FONT></FONT><FONT=20
      face=3D"Comic Sans MS" color=3D#000000 size=3D2></FONT>&nbsp;</P>
      <P><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2>As we all =
know, bones=20
      are living, functioning organs, just like the other organs of the =
body.=20
      Bones require oxygen and glucose in order to produce energy and =
the=20
      metabolic products (red blood cells, endogenous factors of the =
immune=20
      system, etc.) unique to this system. The supply of oxygen and =
glucose is=20
      derived through blood vessels, which are distributed from the hard =

      structure of the bone cortex through the softer skeletal centers. =
In each=20
      of the long bones (tibia, femur) there are a number of openings =
through=20
      which arteries enter the bone, as well as a number of openings =
where veins=20
      exit the bone, which serve to drain the blood back into the =
vascular=20
      system. Most of these openings are concentrated in the area called =
the=20
      Epiphysis, located in the upper part or endpoint of the bone (the =
joint=20
      area). Another feature of the Epiphysis is that the cortex tissue =
in this=20
      area is usually thinner than in the main part of the bone. =
</FONT></P>
      <P><FONT face=3D"Comic Sans MS"><FONT color=3D#000000 size=3D2>The =
structure of=20
      the bone cortex is interesting unto itself, being composed of a =
series of=20
      transport blood vessels called the Haversian canal system, =
situated in=20
      tubular centers called Minerlized Matrix which make up most of the =
hard=20
      cortex, and the Volkman canal system, which crosses through those =
tubular=20
      centers. Looking even deeper inside the space within the bone, we =
find a=20
      system of tubes called the Trabecular space. <BR>This system is =
too=20
      complex for a simple explanation, but it is important to note that =
it=20
      diffuses dissolved materials in the blood, and performs osmosis on =
larger=20
      volumes of fluid to accommodate the system of blood vessels that =
enter and=20
      exit the bone</FONT><FONT size=3D2>.</FONT></FONT></P>
      <P><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</P></TD>
    <TD vAlign=3Dtop height=3D15><FONT face=3D"Comic Sans =
MS">&nbsp;</FONT></TD></TR>
  <TR>
    <TD vAlign=3Dtop height=3D260>
      <P><A target=3D_blank=20
      href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-January/3D"http://www.waismed.com/picturesWin.asp?pic=3D5"><FONT=20
      face=3D"Comic Sans MS"></FONT></A></P>
      <P><FONT face=3D"Comic Sans MS" size=3D2></FONT><A target=3D_blank =

      href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-January/3D"http://www.waismed.com/picturesWin.asp?pic=3D6"><FONT=20
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  <TR>
    <TD vAlign=3Dtop><FONT face=3D"Comic Sans =
MS">&nbsp;</FONT></TD></TR>
  <TR>
    <TD vAlign=3Dtop colSpan=3D2>
      <P><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2>The =
fundamental=20
      principle behind any Intraosseous technique is based on this =
unique=20
      complex of blood vessels. A system that penetrates into the =
Trabecular=20
      space and introduces liquids at a positive pressure will cause =
increased=20
      diffusion "with the current" and in fact pass on quantities of =
water into=20
      the blood system, which drain the Trabecular cavities. </FONT></P>
      <P><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2>In simple =
terms, we are=20
      introducing material into a filtering system with adaptable=20
      permeability.</FONT></P>
      <P><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2>Why the =
adaptable=20
      permeability? For the simple reason that, as the pressure of the =
flow into=20
      the system increases, the molecules that make up the cell =
membranes of the=20
      Trabecular canals, the Haverisan canals and the Volkman canals =
expand,=20
      causing larger drainage spaces for permeability. The result, =
naturally, is=20
      a higher flow volume. </FONT></P>
      <P><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2>Once the =
introduction=20
      of fluid at high pressure is stopped, the system immediately =
returns to=20
      its original size, and will continue to enable transmission of =
fluids,=20
      although at a slower rate, as long as the external pressure =
created by the=20
      fluid is higher than the pressure inside the bone.</FONT></P>
      <P><FONT face=3D"Comic Sans MS" color=3D#000000 size=3D2>These two =

      configurations enable the healthcare provider to supply the rate =
of flow=20
      according to the patient's condition. For example, a patient =
requiring=20
      medication through a drip counter will not need a high-pressure =
flow.=20
      However, a patient who is in hypovolemic shock can receive the =
necessary=20
      quantities of fluids through high-pressure infusion.<BR>This short =

      overview can be summarized by the importance of the channeled =
structure of=20
      the bone interior through which accelerated diffusion allows =
fluids and=20
      medications to be introduced into the blood system. </FONT></P>
      <P><FONT face=3D"Comic Sans MS" size=3D2></FONT>&nbsp;</P>
      <P><FONT face=3D"Comic Sans MS"=20
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