Healthcare and Medicine Reference
In-Depth Information
CHAPTER 12
Access: Emergency - Intraosseous
Access and Venous Cutdown
Matt Boylan
Midlands Air Ambulance, DCAE Cosford, UK
Poor technique
e.g. Infrequent user
OVERVIEW
By the end of this chapter you should be able to:
understand the indications for intraosseous access and venous
Vein damage
e.g. IV drug abuse
Venous shutdown
e.g. shock, cold
cutdown
identify the sites used for intraosseous access and venous
Difficult
intravenous
access
Entrapment
e.g. limited access
Extremes of age
e.g. elderly, infants
cutdown
be aware of different types of intraosseous access devices
describe the procedure of performing intraosseous access and
Limb injuries
e.g. amputations
PPE
e.g. CBRN
venous cutdown
understand the contraindications for intraosseous access and
Environment
e.g. low light
venous cutdown.
Figure 12.1 Diffi cult intravenous access.
Introduction
Compact
bone
Osteon
Gaining access to the circulatory system in the critically ill or injured
patient is an essential part of the resuscitative process. Failure to do
so can result in signifi cant delays in the delivery of life-saving treat-
ment. There are situations where peripheral intravenous access may
be diffi cult or even impossible (Figure 12.1). Intraosseous access
and venous cutdown are useful alternatives in this situation.
Where possible a full explanation of the proceedure should be
given to the patient and informed consent gained. However, in
many cases this will not be possible.
Trabeculae
Periosteum
Haversian or
central canal
Intraosseous access
The intraosseous (IO) space consists of spongy cancellous
epiphyseal bone and the diaphyseal medullary cavity. It houses a
vast non-collapsible venous plexus that communicates with the
arteries and veins of the systemic circulation via small channels
in the surrounding compact cortical bone (Figure 12.2). Drugs or
fl uids administered into the intraosseous space via a needle or
catheter will pass rapidly into the systemic circulation at a rate
comparable with central or peripheral venous access. Any drug,
fl uid or blood product that can be given intravenously can be given
via the intraosseous route.
Volkmann
canal
Figure 12.2 Osseous blood supply.
 
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