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Intraosseous access in the setting of pediatric critical care transport
Brad A Fiorito1, Farrukh Mirza, Theresa M Doran
1Division of Pediatric Critical Care, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Insights
Intraosseous needle placement is a safe and effective method for emergent vascular access in critically ill children during transport. Success rates were similar across different healthcare provider groups, highlighting the importance of this skill.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Vascular Access Techniques
Background:
- Intraosseous (IO) access is crucial for emergent vascular access in critically ill pediatric patients during transport.
- Various healthcare provider groups are involved in pediatric critical care transport, necessitating standardized and effective procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of intraosseous needle placement by different healthcare provider groups during pediatric critical care transport.
- To determine the success rates and complication profiles associated with intraosseous access in this setting.
Main Methods:
- Retrospective chart review of pediatric critical care transports.
- Analysis of intraosseous needle placements performed before arrival at the pediatric intensive care unit.
- Data collection on provider groups, number of attempts, success rates, complications, and patient demographics.
Main Results:
- 47 patients required 58 intraosseous placements, performed by emergency medical technician-paramedics (18%), emergency medicine physicians (42%), and transport team members (40%).
- The overall first attempt success rate was 78%, with a mean of 1.2 attempts per placement.
- Complications were infrequent (12%) and minor, primarily local edema or infiltration.
Conclusions:
- Intraosseous needle placement is frequently required and can be safely performed by various healthcare providers during pediatric critical care transport.
- Similar success rates across provider groups suggest that training and familiarity with intraosseous techniques are beneficial for emergency medical technician-paramedics, emergency medicine physicians, and transport teams.
Objective:
To demonstrate safety and efficacy of intraosseous needle placement among health care provider groups in the setting of pediatric critical care transport.
Design:
Retrospective chart review.
Setting:
Pediatric critical care transports to a pediatric intensive care unit.
Patients:
Children undergoing pediatric critical care transport between January 1, 2000, and March 31, 2002, requiring intraosseous access before arrival to the pediatric intensive care unit.
Interventions:
Intraosseous access placed for emergent vascular access.
Measurements And Main Results:
During the study period, the transport team performed 1,792 transports and identified 47 patients requiring 58 intraosseous placements. These were placed by emergency medical technician-paramedics (18%), referring emergency medicine physicians (42%), and the transport team members (40%). The intraosseous needles were placed with a mean of 1.2 attempts per placement and a first attempt success rate of 78%. Main site of placement was the proximal anterior tibia (95%). Access was maintained for a mean of 5.2 hrs. The intraosseous needle was used for fluids, medications, and laboratory studies. Admitting diagnoses included respiratory distress (28%), cardiopulmonary arrest (26%), neurologic insults (17%), dehydration (15%), sepsis (11%), and other (3%). Ages ranged from 3 wks to 14 yrs (mean 2.2 yrs) and weights from 2.1 to 60 kg (mean 12.3 kg). Complications were noted in seven of 58 (12%), all limited to local edema or infiltration.
Conclusions:
Intraosseous placement is frequently needed in the care of critically ill pediatric patients before they reach the pediatric intensive care unit. We have demonstrated that intraosseous needles can be placed safely with similar rates of success when comparing different provider groups. Emergency medical technician-paramedics, emergency medicine physicians, and pediatric critical care transport teams should be familiar with intraosseous placement.
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