ABSTRACT
This article reports about the perioperative disposition of an intraosseous (IO) needle on a 15 days old critically ill premature infant (weight 1300g) in line with an urgent surgery and sole possible vascular access on circulation insufficiency.Due to vital danger there was perioperatively no time to place a large-bore vascular access in addition to the 2 lying 28G-submerging venous catheters with a minimal flow rate. Because it was not possible to set a secure vascular access in several attempts - with generalised oedema and anasarca -, after having interrupted the surgery, the sole possibility was to dispose an IO needle in the range of the tibia.It was obvious, that a puncture of very small and weak bones is difficult and that a secure bone marrow puncture on infants beyond the weight category of 3 kg declared by the producer can be hard. Anyhow in case of emergency, an attempt is reasonable and useful, the effect after the application on the whole circulation situation was considerably verifiable.
Subject(s)
Infusions, Intraosseous/methods , Intraoperative Care/methods , Sepsis/drug therapy , Abnormalities, Multiple/surgery , Catheters, Indwelling , Critical Illness , Humans , Infant, Newborn , Infant, Premature , Infusions, Intraosseous/adverse effects , Perioperative Period , Respiratory Insufficiency/therapyABSTRACT
We report on a failed epidural puncture for insertion of a catheter during chest wall correction by the minimally invasive procedure according to Nuss in a 16-year-old boy. After insertion of the catheter without any problem and establishment of a symmetrical thoracic analgesia and initiation of general anaesthesia, the catheter was surprisingly observed in the thoracic cavity upon insertion of the endoscopic camera. The catheter was then withdrawn under vision and the operation continued without any further incidents.
Subject(s)
Catheters, Indwelling/adverse effects , Device Removal/methods , Foreign-Body Migration/etiology , Foreign-Body Migration/surgery , Spinal Puncture/adverse effects , Thoracic Cavity/injuries , Adolescent , Humans , Male , Treatment FailureABSTRACT
BACKGROUND: Intraosseous (IO) infusion is a well-established intervention to obtain vascular access in pediatric emergency medicine but is rarely used in routine pediatric anesthesia. METHODS: In this observational study, we report on a series of 14 children in whom semi-elective IO infusion was performed under inhalational anesthesia after peripheral intravenous (IV) access had failed. Patient and case characteristics, technical details, and estimated timings of IO infusion as well as associated complications were reviewed. Data are median and range. RESULTS: IO infusion was successfully established in fourteen children [age: 0.1-6.00 years (median 0.72 years); weight: 3.5-12.0 kg (median 7.0 kg)]. The majority suffered from chronic cardiac, metabolic, or dysmorphic abnormalities. Estimated time taken from inhalational induction of anesthesia until insertion of an intraosseous needle was 26.5 min (15-65 min). The proximal tibia was cannulated in all patients. The automated EZIO IO system was used in eight patients and the manual COOK system in six patients. Drugs administered included hypnotics, opioids, neuromuscular blocking agents and reversals, cardiovascular drugs, antibiotics, and IV fluids. The IO cannulas were removed either in the operating theatre (n = 5), in the recovery room (n = 5), or in the ward (n = 4), after 73 min (19-225 min) in situ. There were no significant complications except one accidental postoperative dislocation. CONCLUSIONS: IO access represents a quick and reliable alternative for pediatric patients with prolonged difficult or failed IV access after inhalational induction of anesthesia.
