Download Agulhas Intra-ósseas

Objectives of this presentation…
• Historical background of intraosseous (I.O.) infusion.
• The anatomical and physiological principle of I.O.
infusion.
• Familiarization with the B.I.G™.
• Indications for I.O. infusion.
• Technique of insertion.
• Medications and fluids.
• Questions.
Historical background of I.O.
infusions…
• First described by Drinker et al., in 1922.
• In 1941, the method was introduced for clinical use
by Tocantis et al., mainly in children.
• Bailey et al. described cannulation of the sternum in
1946.
• Intraosseal regional anesthesia is described by
Thorn-Alquist in 1971.
• 2000, recommended for use in the emergency setting
by ILCOR.
The anatomical and physiological
principle of I.O. infusion…
Utilizes the the emissary
veins that lead from the
intramedullary cavity to
the general circulation.
Anatomy of long bones,
another look…
I.O. infusions, what has been
available until today?
Manually inserted hand held infusion needles have been available for
a number of years.
• Have required a great deal of
skill and experience.
• Are not reliable.
• Difficult to use.
• Often not used by medical
personnel due to associated
psychological barriers.
Introducing the B.I.G™…
Adult B.I.G - 15G
Pediatric B.I.G - 18G
CE & FDA Approved
CE Approved
Design of the B.I.G™…
• Developed to be easily used by a
single rescuer.
• Allows immediate vascular access.
• Permits the rapid infusion of
medications and fluids.
• Minimizes exposure to the patient’s
bodily fluids.
• Can be successfully used by
physicians and paramedics.
Design of the B.I.G™…
Instrument in locked position (before triggering).
Design of the B.I.G™…
After triggering.
Indications for I.O. infusions…
1. TRAUMA
• Fluid replacement in shock.
• Rapid vascular access during mass casualty incidents.
2. NON-TRAUMA
• All cardiac arrests.
• Acute respiratory syndromes (COPD, Asthma, APE).
• When ever rapid vascular access is required.
FROM THE ECC GUIDELINES 2000
Rescuers should increase attention to early
vascular access, including immediate
Intraosseous access for victims of cardiac
arrest, and extend the use of Intraosseous
techniques to victims >6 years
ECC Guidelines 2000: Pediatric Advanced Life Support
When You Might Need I.O.
How It Works
Insertion Technique
Recommended trocar needle penetration
depths:
Adult
Pediatric
6-12 yrs
Tibial tuberosity 2.5 cm 1.5 cm
Medial malleolus 2.0 cm 1.0 cm
Distal radius
Humeral head
1.5 cm
2.5 cm 1.5 cm
Pediatric
0-6 yrs
1.0-1.5 cm
0.75-1.0 cm
-
Insertion Technique
Adults
Find & Mark penetration site
2 cm medially
and 1 cm proximally
to the tibial tuberosity
Insertion Technique
Pediatrics
Find & Mark penetration site
Age 0-6:
1 cm medially
and 1 cm proximally
To the tibial
tuberosity
Age 6-12:
1-2 cm medially
and 1-2 cm
proximally
To the tibial
tuberosity
Insertion Technique
Position the BIG with one
hand to the site
and pull out the Safety Latch
with the other hand.
Insertion Technique
Trigger the BIG at 90° to
the surface.
Insertion Technique
Remove the BIG.
Pull out the stylet trocar.
Insertion Technique
Fix the cannula with
the Safety Latch.
Connect IV Set with a stopcock
Adults: flush with 1mg/ kg
for I.O. local anesthetics.
Insertion Technique
Now 2 – 5 cc of bone marrow can be aspirated into a
heparin-coated syringe for laboratory sampling, or
proceed to inject medications or infuse fluids.
To maintain optimal flow, high pressure, up to 300
mmHg to the infusion bag may be necessary.
Insertion Technique
Recommended insertion sites:
Anatomical insertion point of the tibial tuberosity.
Medications and fluids…
• All medications and fluids can be safely injected into
the B.I.G™.
• I.O. medication and fluid boluses remain the same as
those for I.V. injection.
• It is not recommended that large boluses of
hypertonic solutions be infused through the I.O.
cannula.
• In case of user inaccuracy, or technical malfunction,
it is strongly recommended to always have a second
B.I.G. On hand.
Questions?
Thank you.