[The intraosseal route. When the veins have disappeared]

Area of Science:

• Emergency Medicine
• Pediatric Critical Care
• Vascular Access Techniques

Context:

• Difficult or impossible vascular access is a critical challenge in pediatric emergencies.
• Peripheral or central venous cannulation can be time-consuming and may fail in critically ill children.
• Rapid administration of fluids, electrolytes, and medications is vital for life-saving interventions.

Purpose:

• To evaluate the utility and efficacy of the intraosseous (IO) route for emergency vascular access in pediatric patients.
• To highlight the IO route as a viable alternative when traditional venous access is not feasible.
• To review the indications, optimal insertion sites, administration protocols, and potential complications of IO access.

Summary:

• The intraosseous route provides rapid, easy, and effective vascular access, especially in children under six years old.
• It is indicated in emergencies when peripheral or central cannulation is too slow and the child's life is at risk.
• The proximal or distal tibia and distal femur are preferred insertion sites, with administration similar to the venous route.

Impact:

• The intraosseous route serves as a critical alternative for emergency vascular access, improving patient outcomes in pediatric emergencies.
• It facilitates timely delivery of essential fluids, medications, and electrolytes, as well as specimen collection for laboratory analysis.
• Complications are rare, with compartmental syndrome being the most serious, underscoring the safety and broad applicability of this technique.