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Fri Feb 24 12:38:38 GMT 2006

An Intra-osseous needle is an excellent point of access in a shocked and
unresponsive child ( up to 8- 10 yrs) where central access may not be
immediately available.
It can be done in about 30 secs and you confirm placement by injecting fluid
and not seeing ( or feeling) extravasation which may occur if the placement
is sub-periosteal.
It is the equivalent of central access and you can give all drugs and fluids
via this route until an  alternative ivi route is available.
You need to ensure that it is secured adequately as it may fall out if you
move the child and pull on an unsecured line. It is best to attach an
extension set to the needle so the IVI line is not directly attached to the
proximal end of the needle.
If you can do a cut-down on a femoral vein in 30 secs then you have a useful
alternative and if not, then central vein access can be done at your leisure
Regards
Tony Joseph
Sydney

On 24/2/06 11:08 AM, "bensonblues at comcast.net" <bensonblues at comcast.net>
wrote:

> Pret, I'm not sure what you mean by "objectivity issues", but I will confess
> that being human has its downside. The point I was tring to make is that IO
> needles - in my subjective experience - are very painful, are often associated
> with extravasation, and have an uncertainty about them that you will not
> experience if you expose and visualize a catheter intering into the vein. The
> literature supports my experience. An even more effective method is to expose
> the vein and then use the Seldinger technique to cannulate the vessel with a
> large bore catherter. Using infiltrative anesthesia and skill acquired by
> experience, this method is better tolerated by the patient, more resistent to
> being disloged, and is definitive. Again, I'm not talking about prehospital or
> situations of diress (combat). I oversee the Tactical EMS program at my
> institution (train ER docs to participate with Wayne County SWAT) and in those
> situations, one must do what one can - ideally after getting the victi
>  m to safety and out of range of fire. IOs are probably great in that
> scenario. Finally, whatever method you choose (short 12 to 14 ga peripheral
> catheters are still best [Poiselle's Law]- if you can place them), success
> depends largely upon the experience of the person performing them. In the end,
> we do what we can. DB
> --
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