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The Evidence-Based Use Of Intraosseous Lines In Pediatric Patients - $30.00
Publication Date
June 2012 (Volume 9, Number 6)
CME
This issue includes 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category 1 credits, 4 AAP Prescribed credits, and 4 AOA Category 2A or 2B CME credits.
Author
Emily C. Rose, MD
Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Keck School of Medicine at Los Angeles County and University of Southern California Medical Center, Los Angeles, CA
Peer Reviewers
Matthew Hansen, MD
Adjunct Instructor and Fellow, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR
Charles T. Stiles, MD, FACEP, ATP, CFII MEII
Medical Director, Emergency Services, Scott & White Healthcare at Hillcrest, Temple, TX
Abstract
For pediatric resuscitation, vascular access must be established quickly, often in difficult circumstances. Alternative methods of peripheral access, such as umbilical catheter, central venous lines, venous cut-down, and ultrasound-guided access, may be poor options because of the patient’s age or condition, the urgency of resuscitation, and/or the skill of available clinicians. When peripheral access fails after 3 attempts (or in 90 seconds), an intraosseous line offers emergency clinicians a fast and effective alternative for venous access in children of all ages. They can be inserted within 5 to 60 seconds, and they require little clinician experience or training and minimal equipment. The American Heart Association, the International Committee on Resuscitation, and the American College of Surgeons all recommend intraosseous line use. Although contraindications include existing bone fracture or bone disease, complication rates are similar to central venous catheters. This review looks at the guidelines, recommendations, and evidence on using intraosseous lines in pediatric patients and gives information about mechanical devices used, techniques for insertion, and possible complications.
Excerpt from the issue
It is a quiet Sunday morning in your single-coverage ED when the base station alerts you that they are bringing a 3-year-old girl who is actively seizing. The child’s mother gave rectal diazepam at home and paramedics gave buccal midazolam, but the child is still seizing when she arrives. By this time, she has been actively seizing for 30 minutes. Paramedics were unable to secure a line, and 3 nurses are frantically trying to start an IV as the child thrashes around on the gurney. Your highly skilled charge nurse successfully secures a small line in the foot, but the vein blows during her flush. What should you do now?