Pediatric Intraosseous Vascular Access

The medical literature is rich with articles describing the use of IO infusion in the pediatric patient population. Since 1941, there have been over 150 articles in peer-reviewed journals describing pediatric IO use. The majority are case reports or overview articles on IO access. We review a few of the key article on pediatric IO use below.

IO infusion was first described in the 1920s,1 but wasn’t widely accepted in Europe and North America until the 1930s and 1940s, respectively, when studies showed the utility in children.2,3 Although IO vascular access in not commonly used for newborn infants, some clinicians have recommended the technique for neonatal patients as alternative vascular access for medication and fluids when direct venous or umbilical routes are not available.4 IO access was shown to be faster and easier than umbilical venous access.5

A 2005 retrospective chart review demonstrated the safety and efficacy of IO needle placement during pediatric critical care transport. Investigators identified 47 patients requiring 58 IO placements; with a first attempt success rate of 78%. 6 Complications were noted in 12% of patients, all limited to local edema or infiltration. The investigators concluded that intraosseous vascular access was often necessary for critically ill pediatric patients prior to arrival at the pediatric intensive care unit, and that intraosseous needles can be placed safely.

A second 2005 retrospective study looked at 129 pediatric patients suffering from major trauma. They observed a high 64% mortality, with most deaths attributed to the severity of injury, and the difficulty in obtaining venous access. The investigators recommended IO training for all personnel involved with pediatric trauma resuscitation.7 A recent meta-analysis of 17 studies encompassing 7,617 emergency patients concluded that medications were often given too late, even in the studies in which drug delivery was the primary study intervention.8They suggested obtaining intravascular access early in the rescue process, specifically advocating IO access.

References

  1. Drinker CK, Drinker KR, Lund CC. The circulation in mammalian bone marrow. Am J Physiol 1922:62:1-92.
  2. Heinild S, Sondergaard T, Tudvad F. Bone marrow infusion in childhood: experiences from a thousand infusions. J Pediatr 1947;30:400-12.
  3. Tocantins LM, O’Neill JF, Jones H. Infusion of blood and other fluids via the bone marrow: Application in pediatrics. JAMA 1941a;117:1229-34.
  4. Haas NA. Clinical review: vascular access for fluid infusion in children. Critical Care 2004; 8(6):478-84.
  5. Abe KK, Blum GT, Yamamoto LG. Intraosseous is faster and easier than umbilical venous catherization in newborn emergency vascular access models. Am J Emerg Med 2000;18:126-9.
  6. Fiorito BA, Mirza F, Doran TM, Oberle AN et al. Intraosseous access in the setting of pediatric critical care. Pediatric Critical Care 2005;6(1):50-3.
  7. Smith R, Davis N, Bouamra O, Lecky F. The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients. Injury 2005;36(9):1034-8.
  8. Rittenberger JC, Bost JE, Menegazzi JJ. Time to give the first medication during resuscitation in out-of-hospital cardiac arrest. Resuscitation 2006;70(2):201-6.