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Intraosseous access in infant resuscitation
  1. ROSS FISHER, Specialist Registrar, Paediatric Surgery
  1. Royal Bristol Hospital for Sick Children
  2. St Michael's Hill
  3. Bristol BS2 8BJ, UK
    1. DYLAN PROSSER, Consultant Paediatric Anaesthetist
    1. Royal Bristol Hospital for Sick Children
    2. St Michael's Hill
    3. Bristol BS2 8BJ, UK

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      Editor,—We believe that intraosseous access to the circulation in infant resuscitation is undervalued and therefore under utilised.

      Intraosseous cannulation is a simple and effective technique that can be performed both quickly and safely in resuscitation.1-4There have been relatively few complications reported with this technique.5

      In a laboratory study, we compared the average flow rates through a range of intravenous cannulae with that of an 18 gauge intraosseous cannula. We purged intravenous Hartmann's solution through the various devices, at a constant pressure of 300 mm Hg, recording the average volumes over one minute intervals. The results and calculated infusion time for a 20 ml/kg bolus in a 5 kg baby are shown in table1.

      Table 1

      Results and calculated infusion time for a bolus in a 5 kg baby

      Administration of intravenous fluid is an essential component of infant resuscitation. Fluid boluses have to be infused under pressure through an intravenous cannula placed in a peripheral vein. Successful cannulation can be a technical challenge in collapsed infants. Small veins are prone to damage when fluids are rapidly purged through them. Central venous access is not usually established in infants in the immediate resuscitation period and larger intravenous cannulae (22 and 20 gauge) can be difficult to site in small infants presenting with circulatory failure.

      Our simple experiment has shown that fluids can be infused through an intraosseous cannula at a significantly higher rate to that of the intravenous devices. The resistance to flow in situ has not been calculated, but one could reasonably expect the capacitance of the marrow cavity to be greater than that of an infant's peripheral vein. These factors, in addition to the ease and success of placement of intraosseous over intravenous cannulae, leads us to advocate that greater emphasis is placed on the value of intraosseous cannulation during the early phase of resuscitation in infants.

      This is an important issue that should be addressed both locally and nationally, as well as through advanced life support provider courses (APLS/PALS).

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