Interosseous Access in Adults
Recent problems with IV access in patients with dengue shock syndrome has brought to light interosseous(IO) access, even in adults. Unfortunately, unlike in pediatrics, the expertise of inserting IO lines among adult medical staff is lacking.
IO access was first researched among military personnel especially during combat situations, where IV access may be difficult. It has also been advocated during pre-hospital emergency care when iv access is difficult.
How much fluids can we run into the marrow cavity in adults? What are the complications of such a procedure? Are there better alternatives?
IO lines are not advocated more than 24 hours, during which time an IV access is preferable or a new site of IO is made. The risk of infection in prolonged IO access is a concern. Getting the needle into the marrow proper in adults can be difficult as the marrow has contracted in most long bones. Improperly placed IO lines can pose more problems. Insertion of IO lines can be very painful and sedation will be necessary. In the context of shock, sedation may not be ideal. On most occasions, the patients would have to be artificially ventilated first.
Alternatives are centrally placed lines or a venous cut-down. Unfortunately, these procedures require time to be inserted, a luxury not available in must resuscitations.
So should IO lines be advocated in our patients especially those with dengue?
IO access was first researched among military personnel especially during combat situations, where IV access may be difficult. It has also been advocated during pre-hospital emergency care when iv access is difficult.
How much fluids can we run into the marrow cavity in adults? What are the complications of such a procedure? Are there better alternatives?
IO lines are not advocated more than 24 hours, during which time an IV access is preferable or a new site of IO is made. The risk of infection in prolonged IO access is a concern. Getting the needle into the marrow proper in adults can be difficult as the marrow has contracted in most long bones. Improperly placed IO lines can pose more problems. Insertion of IO lines can be very painful and sedation will be necessary. In the context of shock, sedation may not be ideal. On most occasions, the patients would have to be artificially ventilated first.
Alternatives are centrally placed lines or a venous cut-down. Unfortunately, these procedures require time to be inserted, a luxury not available in must resuscitations.
So should IO lines be advocated in our patients especially those with dengue?
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