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Adult Intraosseous Infusion for Career Medics
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INTRODUCTION
Standard vascular access in the adult patient involves the
peripheral venous system. Under conditions in trauma, the
peripheral veins often collapse. Intraosseous infusion for the
pediatric patient has been used for several years. In the past,
adult intraosseous infusion was used in some cases to give medications,
but the flow rate was too slow to be used for fluid resuscitation of
adult trauma patients. Recently a device has been developed that
allows rapid fluid replacement and allows adult intraosseous infusion
to be used for fluid resuscitation and for administration of
medications.
EQUIPMENT
Alcohol Preps
F.A.S.T. 1 Adult Intraosseous Device
Tape
INDICATIONS
The adult patient who is in cardiac arrest and in whom you cannot
quickly obtain peripheral venous access.
Hypovolemic adult patients who have a prolonged transport and in
whom you are unable to quickly (Two sticks or 90 seconds) obtain venous
access.
Ordered obtained from physician. Order NOT needed
if patient in arrest
Trained on device and re-trained every 6 months
CONTRAINDICATIONS
Fractured sternum
Recent sternotomy
Severe osteoporosis or bone-softening conditions.
POSSIBLE COMPLICATIONS
If infiltration occurs (RARE), you must abort the procedure.
This is the only bone in which the device is used.
Potential complications are the following:
Subperiostial complications due to improper placement.
Osteomyelitis
Localized infection , < 1%
Fat embolism
Marrow damage (From Medication)
Pain in conscious patient with insertion or rapid infusion
TECHNIQUE
1)
Place the target patch at the site. The single recommended site
of insertion is the adult manubrium, on the midline and 1.5 cm below
the sternal notch. The site is prepped with aseptic technique,
and the index finger is used to align the target patch with the
patient’s sternal notch.
2)
With the patch securely attached to the patient’s skin, the introducer
is placed in the target zone, perpendicular to the skin. A firm
push on the introducer releases the infusion tube into the correct site
and to the right penetration depth. The introducer is pulled
straight back, exposing the infusion tube and a two-part support sleeve
that falls away.
3)
Correct placement is verified by observation of marrow entering the
infusion tube. The infusion tube is joined to tubing on the
patch, which is connected to a purged source of fluid. Fluid can
now flow to the patient.
The protector dome is pressed down firmly
over the target patch to engage the Velcro fastening. The site is
clearly visible through the dome, the infusion tube and connection
tubing move easily with the strain on the skin, and the site requires
no further stabilization while the patient is transported.
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