Intraosseous Infusion: Not Just for Kids Anymore
The potential use of intraosseous (IO) infusions for adults was first examined 80 years ago.
Patient Population: Though commonly thought of only in the realm of resuscitation efforts for our pediatric patients under age six, intraosseous devices are now recommended for use in all age groups. The American Heart Association (AHA) Pediatric Advanced Life Support (PALS) textbook states that rescuers should "extend the use of intraosseous techniques to victims greater than six years old."41 The AHA Advanced Cardiac Life Support textbook describes intraosseous infusion as "a promising technique to establish emergency access in adult patients."19 In addition, IO devices continue to be used in nontraditional patient situations such as burns, trauma and simulated chemical/biological/nuclear disaster training.4,26
Bone Injection Gun: This spring-loaded, impact-driven intraosseous device (Figures 6 and 7) from WaisMed, Yokneam, Israel, comes in both a pediatric and an adult size. Simply pull the trigger and the needle is injected to a preset depth. Though it's most commonly used in the pediatric or adult tibia, researchers describe its use in the radius, ulna and humerus as well.9,12,26,33,39,42-45
F.A.S.T.-1: This IO device (Figure 8) from Pyng Medical Corp., Richmond, BC, Canada, is designed be placed in the sternum. A guide is placed on the upper part of the sternum to mark placement, and the device uses a "bed of needles" to control the depth. With manual pressure, the IO device is inserted into the sternum and the infusion tube is left in place.9,12,33,46
EZ-IO: The design for this IO device (Figures 9 and 10, VidaCare, San Antonio, TX) came from the experiences of orthopedic surgeons who use drills to safely enter bone. The EZ-IO is a handheld, battery-powered drill with an IO needle attached. This device allows the operator to control the pressure or force used during insertion, and thereby determine the exact depth of needle placement.47
Comparison
In the challenging prehospital environment, having alternative methods for fluid resuscitation or medication administration like IO devices could mean the difference between life and death. The newest IO devices offer some interesting alternatives to the items that we have been using. In situations where pelvic or lower-extremity injuries are common, the ability to use sites other than the tibia may be important. In addition, certain air medical services may have limited access to the patient during transport, making the placement of the F.A.S.T.-1 sternal device more attractive. The compact nature of the Bone Injection Gun offers advantages to services where size and weight are important considerations. The controlled insertion and lack of bone trauma afforded by the EZ-IO may be critical issues to others. Ultimately, the decision of which IO device(s) to carry is one that needs to be made by the individual service and its medical director, but it is encouraging that there are a number of different products available, and that developments in both pediatric and adult IO equipment continue.
Conclusion
The importance of understanding and applying the principles of IO infusion has never been stronger. The potential applications for intraosseous access have increased and we can expect more interest in and emphasis on this lifesaving technique in the foreseeable future. Both in the civilian and military environments, where time is critical and conditions can be less than optimal, IO infusion may be the access of choice.
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