Intraosseous access in the setting of pediatric critical care transport.
OBJECTIVE
To demonstrate safety and efficacy of intraosseous needle placement among health care provider groups in the setting of pediatric critical care transport.


METHODS
Retrospective chart review.


METHODS
Pediatric critical care transports to a pediatric intensive care unit.


METHODS
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.


METHODS
Intraosseous access placed for emergent vascular access.


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.
Fiorito
Brad A
BA
Division of Pediatric Critical Care, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Mirza
Farrukh
F
Doran
Theresa M
TM
Oberle
Anita N
AN
Cruz
Eleanor C Vince
EC
Wendtland
Cherry L
CL
Abd-Allah
Shamel A
SA
D002140:California; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education / Q000592:standards; D004638:Emergency Treatment / Q000379:methods / Q000592:standards*; D006801:Humans; D007223:Infant; D017148:Infusions, Intraosseous / Q000379:methods / Q000592:standards*; D015278:Intensive Care Units, Pediatric; D008485:Medical Audit; D010360:Patient Transfer / Q000379:methods / Q000592:standards; D010372:Pediatrics / Q000193:education / Q000592:standards; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000592:standards*
D002316:Cardiotonic Agents