Brief Reports
Safety and Efficacy of Intraosseous Lines in Neonates
Source: Ellenmunter H, et al. Intraosseous lines in preterm and full term neonates. Arch Dis Child Fetal Neonatal Ed 1999;80:F74-F75.
In primary resuscitation of neonates, parenteral treatment with fluids, medications, and/or drugs may be required for shock, apnea, or cardiac arrest. Under these clinical conditions, it may be impossible to administer these through peripheral veins because of venous inaccessibility. The umbilical vein is often the preferred route for intravenous access, but it may be dangerous to administer a number of drugs directly into the umbilical vein. Intraosseous infusion offers an alternative. Neonates have a highly vascular marrow and there are no pharmacokinetic differences between agents administered by either intravenous or intraosseous routes.
Ellenmunter and associates at the Innsbruck University Hospital in Austria report their experience with the use of intraosseous lines for the resuscitation of 20 premature and seven term newborns within five hours of birth in whom conventional venous access had been unsuccessful. An #18 gauge bone marrow or intraosseous infusion needle was inserted into the marrow space beneath the medial plate of the proximal tibia, 0.5-1.0 cm distal to the tibial tuberosity. Correct placement was confirmed by aspiration of bone marrow. The intraosseous line was replaced by an intravenous one as soon as possible when the child’s condition was stable. The needles were left in place for 30 minutes to 20 hours. Substances infused included: catecholamines, volume expanders, sodium bicarbonate, analgesics, sedatives, muscle relaxants, glucose, blood or blood products, and antibiotics.
There were no failed attempts, although three patients required placement of a second intraosseous needle because of dislocation or malfunction of the first needle. All patients survived the initial resuscitation using intraosseous lines. Clinical responses indicated that intraosseous infusions to correct hypotension, hypoperfusion, and hypoglycemia were successful. Possible complications from intraosseous needles include skin necrosis and infection, osteomyelitis, fracture, and extravasations. In Ellenmunter et al’s report, there were only two complications: one patient had skin necrosis secondary to extravasation of hypertonic glucose; another patient had a hematoma secondary to extravasated blood during an RBC transfusion. Fifteen of these patients survived the neonatal period and there were no long-term effects on the limb growth. Ellenmunter et al conclude that intraosseous infusions are quick, safe, and effective for the resuscitation of compromised neonates and that the emergency set in every delivery suite and neonatal intensive care unit should be equipped with intraosseous needles. —
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