Aslı KAVAZ, Öztürk Burcu HİŞMİ, Tanıl KENDİRLİ, Zahide YALAKİ, Emel DERELLİ, Erdal İNCE

A life-saving line in resuscitation and shock management of the critically ill child: intraosseous infusion

Amaç: Kemik içi (Kİ) infüzyon acil durumlarda damaryolu açılamadığında ilaç ve sıvı tedavisi için alternatif bir yoldur. Bu yolla canlandırma sırasında ve şokta epinefrin, adenozin, kristaloid, kolloid ve kan ürünleri etkin bir şekilde uygulanabilir. Gereç ve Yöntem: Yoğun bakım ünitesinde yatmış ve Kİ infüzyon tedavisi uygulanmış olan hastaların dosyaları retrospektif olarak incelenerek, bu tedavinin yapıldığı hastalar ve komplikasyonlar değerlendirildi. Bulgular: Yoğun bakım ünitemizde yatan 332 hastadan 13 (3.9%)'üne Kİ infüzyon tedavisi uygulandı. Hastalarımızda median yaş 8 ay, erkek kız oranı 2.5 bulundu. Kİ infüzyon tedavisi uygulanan hastaların tanıları septik şok (6), kardiyojenik şok (2), akut gastroenterit (1), hemorajik şok ve ensefalopati sendromu (4) idi. Ki infüzyonu 13 hastadan 2'sine canlandırma sırasında uygulandı. On (76.9%) hastaya spinal iğne, 3 hastaya ise kemik fliği asptrasyon iğnesi île Kİ infüzyonu yapıldı. Sekiz (61.64%) hasta daha önceden hastanede yatmaktaydı. Kemik içi infüzyon tedavisi 12 hastada sağ proksimal tibia, 2 hastada sol proksimal tibia ve bir hastada sağ distal femurdan uygulandı. Kemik İçi uygulanan iğneler ortalama 20 saat (3 saat-9 gün) kaldı ve 11 hasta 24 saatten uzun süre yaşadı. Hastalardan sadece birisinde 1 kez görülen ilaç ekstravazasyonu, tek komplikasyon idi. Sonuç: Kemik içi infüzyon tedavisi hayati tehdit eden ve damar yolu açılmasının gerekti olduğu durumlarda, kolay ve etkin bir yöntem olarak akılda tutulmaiıdır.

Kritik olarak hasta olan çocuğun canlandırılması ve şok tedavisinde yaşam kurtarıcı bir yol: kemik içi infüzyon

Aim: Intraosseous infusion (101) is an alternative method of vascular access which is considered when peripheral intravenous line cannot be achieved rapidly. Epinephrine, adenosine, crystalloids, colloids and blood products can be administered effectively using this route during resuscitation and shock management. Material and Methods: We retrospectively evaluated the medical records of Pediatric Intensive Care Unit (PICU) patients who had required 101 administration, and the complications of this method are searched. Results: Medical records of 332 patients who had been followed in our PICU were examined and 13 patients (3.9%) were detected to have 101 administered. Our patients' median age was 8 months, and male:female ratio was 2,5. The primary diagnoses of our 101 administered patients were septic shock (6), cardiogenic shock (2), acute gastroenteritis (1), hemorrhagic shock and encephalopathy syndrome (4). 101 were performed 2 of 13 patients during resuscitation.'We performed 101 by spinal needle in 10 (76.9%) patients and by bone marrow aspiration needle in three patients. Eight (61.64%) patients were inpatient. The sites for placement of IO line were right proximal tibia in 12 patients, left proximal tibia in 2 patients, and right distal femur in one patient. The median time of 101 was 20 hours (3 hours-9 days), and 11 patients survived in the first 24 hours.The only cohipllcatiort Was extravasation, seen in a patient. Conclusion: IOI is indicated in life-threatening situations in which vascular access is essential for treatment, and should be kept in mind for being an easily achieved vascular access.

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1. McDonald MJ, Wiebe RA. Intraosseous infusions. In: Levin DL, Morriss FC (eds): In Essentials of Pediatric Intensive Care (ed 1). Newyork, Churchill Livingstone, 1997; 1249-52.
2. Kentner R, Haas T, Gervais T, Hiller B, Dick W. Pharmacokinetics and phermacodynamics of hydroxyethyl starch in hypovolemic pigs; a comparison of peripheral and intraosseous infusion. Resuscitation 1999; 40:37-44.
3. Stoll E, Golej J, Burda G, Hermon M, Boigner H, Trittenwein G. Osteomyelitis at the injection of adrenalin through and intraosseous needle in a 3-month-old infant. Resuscitation 2002; 53:315-8.
4. Bowley DMG, Loveland J, Pitcher GJ. Tibial fracture as a complication of intraosseous infusion during pediatric resuscitation. J Trauma 2003; 55:786-787.
5. Korszun T, Raio CC, Theodoro D, Nelson MJ, Hormozdi S, Lee DC, Elliott D. Can emergency physicians utilize ultrasonography to accurately confirm intraosseous needle placement? Ann Emerg Med 2004; 44:S84.
6. Boon JM, Gorry DLA, Meiring JH. Finding an ideal site for intraosseous infusion of the tibia: an anatomical study. Clin Anat 2003; 16:15-18.
7. European Resuscitation Council. Guidelines 2000 for cardiopulmonary resuscitation and cardiovascular care-an international consensus on science. Resuscitation 2000; 46:359.
8. McCarthy G, O'Donnell C, O'Brien M. Successful intraosseous infusion in the critically ill patient does not require a medullary cavity. Resuscitation 2003; 56:183-186.
9. Clem M, Tierney P. Intraosseous infusions via the calcaneus. Resuscitation 2004; 62:107-12.
10. Foex BA. Discovery of the intraosseus route for fluid administration. J Accid Emerg Med 2000; 17:136-137.
11. Simmons CM, Johnson NE, Perkin RM, van Stralen D.Intraosseous extravasation complication reports. Ann Emerg Med 1994; 23:263-266.
12. Glaeser PW, Losek JD. Emergency intraosseous infusions inchildren. Am J Emerg Med 1986; 4:34-36.
13. Glaeser PW, Losek JW, Nelson DB. Pediatric intraosseous infusions: impact on vascular infusion time. Am J Emerg Med 1988; 6:330-332.
14. Fiorito BA, Mirza F, Doran TM, Oberle AN, Cruz ECV,Wendtland CL, Abd-Allah SA. Intraosseous access in the setting of pediatric critical care transport. Pediatr Crit Care Med 2005;6:50-53.