弹射式单兵快速骨髓腔输液器在急危重患者抢救中的应用

目的验证骨髓腔输液在急危重症患者抢救中的应用效果。方法对2014年1-3月来我院急诊的15例危重患者,在90s内未成功建立外周静脉通道时,进行了骨髓腔穿刺并输液,做好全程护理。结果 15例患者穿刺成功率为100%,均未发生相关并发症。结论骨髓腔输液快速便捷,操作简单易行,能作为急危重症患者抢救输液通道建立的操作方法。     

1例危重症患者行骨髓腔内输液的护理

骨髓腔内输液(IO)是一种在特殊情况下建立的紧急输液方法 ,是利用长骨骨髓腔中丰富的血管网将药物和液体经骨髓腔输入血液循环,当无法建立静脉通路时,IO是抢救成功的关键所在。本研究报道1例心力衰竭,非ST段抬高性心肌梗死,存在导管相关性感染,且外周静脉穿刺成功困难的患者,通过建立IO通道,及时给予抢救药物,并成功挽救了生命。护理要点为严格掌握建立IO通道的时机,密切监测生命体征,合理掌握输液速度,做好骨髓炎、局部漏液等并发症预防护理。     

骨髓腔输液在我国的临床应用进展

临床工作中,尤其是抢救急危重症患者时,输液与给药通道往往被称为"生命线"。最多见的"生命线"是通过静脉输液通路建立的,常采用的有浅静脉和深静脉两组。骨髓腔输液[1](IO)是一项早年就曾出现但后来被长期"冷藏",近年来     

骨髓腔穿刺建立循环对心搏骤停患者自主循环恢复的影响

在心搏骤停患者的抢救治疗中,快速建立静脉通路并尽早给予复苏药物治疗与患者的复苏成功率密切相关,而且直接影响心肺脑复苏的效果.为了提高抢救的效果,国内外学者在心肺复苏(CPR)的流程、技术方面进行了大量研究.本研究中采用EZ-IO骨髓腔内注射系统经骨髓腔建立静脉通路,观察其对呼吸、心搏骤停患者的复苏效果,并与经锁骨下静脉和外周静脉输液通路复苏进行比较.     

胫骨骨髓腔输液在危重患儿急救中的应用

在危重患儿抢救中,开放血管通路对输注液体和药物至关重要。而儿科危重患儿特别是需要抢救复苏的患儿,静脉通路的开放通常比较困难,对于休克、心肺骤停的婴幼儿,如果数分钟内无法获得外周静脉通路,则骨内途径是一个可靠的替代途径。本院对9例危重患儿选择胫骨骨髓腔穿刺输液给药均获得成功,取得了较好的效果,现报告如下。     

骨髓通路在院内危重症患者抢救中的应用效果评价

目的分析骨髓通路在院内危重症患者抢救中的应用效果。方法回顾性收集68例危重症患者的临床资料及输液通路应用情况,以不同输液通路进行分组,分析静脉通路组与骨髓通路组患者的一般资料及输液通路应用效果。结果首次穿刺成功率骨髓通路组高于静脉通路组,通路相关并发症骨髓通路组低于静脉通路组,通道建立时间及通路开始建立血压回升时间骨髓通路组低于静脉通路组,经比较,差异均有统计意义。结论骨髓通路能有效缩短输液通路建立的平均时间,首次穿刺成功率高,且相关并发症低。     

老年患者静脉输液的注意事项

外周静脉输液是临床治疗和抢救病人所采取的最有效重要措施之一。尽快为患者建立静脉通路，确保药物的输入，是抢救成功的关键，也是供给营养重要途径。[第一段]     

骨髓腔输液在创伤急救中的应用

目的:研究和评价骨髓腔输液在创伤急救中的应用价值.方法:急救时无法快速建立静脉通道而又急需输液治疗的创伤危重成人患者36例,对其进行骨髓腔输液,通过通道建立时间、测量血压、判断周围静脉充盈度等方法进行评价.结果:36例患者均在快速输液后血压回升,外周静脉充盈度良好.结论:骨髓腔输液对危重创伤患者可迅速建立输液通道,达到快速补液、用药的目的,在创伤急救中有重要的临床应用价值.     

胫骨骨髓腔输液在危重患儿急救中的应用

在危重患儿抢救中,开放血管通路对输注液体和药物至关重要.而儿科危重患儿特别是需要抢救复苏的患儿,静脉通路的开放通常比较困难,对于休克、心肺骤停的婴幼儿,如果数分钟内无法获得外周静脉通路,则骨内途径是一个可靠的替代途径[1-3].本院对9例危重患儿选择胫骨骨髓腔穿刺输液给药均获得成功,取得了较好的效果,现报告如下.     

最便捷和安全的输液方式——骨髓腔输液

能够安全、便捷和可靠地进行输液是救治急危重症患者的基本要求,既往主要通过静脉通路实现.就建立静脉通路的途径、原则和方法 ,我们总结出8个部位和16个点:浅静脉(外周静脉):颈外静脉、头静脉、贵要静脉、大隐静脉;深静脉(中心静脉):颈内静脉、锁骨下静脉上入路、锁骨下静脉下入路、股静脉,以方便不同操作者对不同患者、不同目的 和在不同环境下选择[1].然而,即使最方便和快捷的点位,也需要专业的医务人员完成,且还有可能受到某些条件的限制.     

Emergency applications of intraosseous infusion

Vascular access is an important step in the care of the critically ill child but can be very difficult and time consuming. Recently, intraosseous infusion has experienced a resurgence as a rapid alternative to venous cannulation. Several cases illustrate the usefulness of this technique in the emergency department. Included are the first reports of the use of intraosseous diazepam and succinylcholine.     

Comparison of intraosseous access and central venous catheterization in Chinese adult emergency patients: A prospective,multicenter, and randomized study

BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous (IO) access and central venous catheterization (CVC) in critically ill Chinese patients.     

Successful intraosseous infusion in the critically ill patient does not require a medullary cavity

OBJECTIVES: To demonstrate that successful intraosseous infusion in critically ill patients does not require bone that contains a medullary cavity. DESIGN: Infusion of methyl green dye via standard intraosseous needles into bones without medullary cavity-in this case calcaneus and radial styloid-in cadaveric specimens. SETTING: University department of anatomy. PARTICIPANTS: Two adult cadaveric specimens. MAIN OUTCOME MEASURES: Observation of methyl green dye in peripheral veins of the limb in which the intraosseous infusion was performed. RESULTS: Methyl green dye was observed in peripheral veins of the chosen limb in five out of eight intraosseous infusions into bones without medullary cavity-calcaneus and radial styloid. CONCLUSIONS: Successful intraosseous infusion does not always require injection into a bone with a medullary cavity. Practitioners attempting intraosseous access on critically ill patients in the emergency department or prehospital setting need not restrict themselves to such bones. Calcaneus and radial styloid are both an acceptable alternative to traditional recommended sites.     

The Role of Intraosseous Vascular Access in the Out-of-Hospital Environment (Resource Document to NAEMSP Position Statement)

Thousands of critically ill emergency patients are treated in the out-of-hospital setting in the United States every year. In many patients intravenous (IV) therapy cannot be initiated because of inadequate access to peripheral veins. In some cases, this lack of vascular access may limit benefit of medications because of late administration.[[]] Both speed andoverall success of vascular access are important when evaluating potential methodologies for their use in the out-of-hospital environment. Insertion of an IV cannula has been reported to require substantial time in the prehospital environment, with a recent study reporting an average successful intravenous line placement time of 4.4 ± 2.8 minutes.[[]] In critically ill pediatric patients, vascular access may present substantial difficulties to the provide.[[]] Intraosseous access may provide a significant time saving which may benefit many critically ill patients, both by decreasing the time to achieve access andby decreasing the time to administration of indicated medications.[[]] Achieving rapid administration of medications may facilitate the care of critically ill patients.[[]] Devices are now available that permit rapid, accurate access to the intraosseous space. Recent changes in the American Heart Association's resuscitation guidelines state that the intraosseous route should be the first alternative to difficult or delayed intravenous access.[[]] With these considerations, the role of intraosseous vascular access in the out-of-hospital environment should be reemphasized.     

Intraosseous Access

Background: Vascular access is of paramount importance in the care of the critically ill patient. When central or peripheral intravenous access cannot be accomplished in a timely manner, intraosseous access and infusion is a rapid and safe alternative for the delivery of fluids, medications, and blood products. The resurgence of the use of intraosseous access in the 1980s led to the development of new methods and devices that facilitate insertion. Objectives: This article discusses general indications, contraindications, and complications of intraosseous access and infusion, focusing on new devices and their insertion. Discussion: Current research is focused on product innovation and improving drug delivery using intraosseous autoinjectors, finding new anatomic sites for placement, and expanding the use of different intraosseous devices to the adult population. Conclusions/Summary: New, improved intraosseous systems provide health care providers with choices beyond traditional manual intraosseous access for administering fluids.     

Intravascular access in pediatric cardiac arrest

All cases of patients aged less than 48 months who presented in cardiac arrest to the Hennepin County Medical Center's emergency department (ED) during the years 1984 to 1986 were reviewed retrospectively. The ED record, initial and subsequent chest radiographs, hospital charts, and autopsy reports were analyzed. A total of 33 cases were reviewed. The average patient age was 5 months. The average time needed to establish intravascular access was 7.9 +/- 4.2 minutes. Success rates were 77% for central venous catheterization, 81% for surgical vein cutdown, 83% for intraosseous infusion, and 17% for percutaneous peripheral catheterization. Percutaneous peripheral catheterization, when successful, and bone marrow needle placement were the fastest methods of obtaining intravascular access. There were no major immediate complications, and delayed complications were minimal. Attempts at peripheral intravenous catheter placement should be brief, with rapid progression to intraosseous infusion if peripheral attempts are not successful.     

The intra bone passage and nursing

The authors confirm the utility of the intra bone passage as a means of emergency vascular access when the installation of a peripheral and/or central venous passage is difficult or impossible when attending critically ill patients as another additional technique available to Nursing when caring for a critically ill patient. From the reference articles reviewed, the authors deduce that intra bone vascular access provides a passage to the vascular system which permits rapid, easy and efficient access, especially when attending children under the age of six. The use of the intra bone passage is justified whenever medical personnel take more than 90 seconds or have three failed tries to insert a peripheral venous tube in patients who are critically ill or unstable. The anatomical zones which are the most appropriate to puncture in children are the proximal and distal part of the tibia and the distal section of the femur. This intra bone passage permits the administering of liquids and drugs, just as a peripheral venous passage does. Both the complications and the countermeasures are minimal.     

Feasibility of point-of-care colour Doppler ultrasound confirmation of intraosseous needle placement during resuscitation

Introduction

Intraosseous needle insertion for vascular access is a standard procedure used in paediatric resuscitation. The introduction of newer automated intraosseous devices has recently expanded its role to include resuscitation in patients of all ages. Managing resuscitation can be challenging and a misplaced intraosseous needle may confound effective resuscitation. Colour Doppler ultrasound has been recently proposed as a method to confirm intraosseous needle placement. The ability to rapidly determine the correct position of an intraosseous needle during resuscitation would allow the delivery of medication or fluid infusion into the vascular space to be verified, thus optimizing resuscitation. Furthermore, complications from intraosseous infusion extravasating into soft tissues, such as compartment syndrome, or tissue necrosis can be avoided.

Methods

We describe the point-of-care sonographic technique and colour Doppler ultrasound findings of intraosseous needle confirmation in a case series of critically ill patients requiring resuscitation, highlighting the utility of this sonographic application.

Results

Colour Doppler ultrasound detected extraosseous flow in incorrectly positioned intraosseous needles, and intraosseous flow in correctly positioned intraosseous needles in six critically ill patients requiring resuscitation.

Conclusions

The use of point-of-care colour Doppler ultrasound to determine the location of both manually inserted or automated placement of intraosseous access during resuscitation is feasible, can be rapidly performed, may verify delivery of resuscitative medications or infusions, and avoid complications from extravasation.     

骨髓腔输液在心搏骤停患者急救中的应用效果

目的探讨骨髓腔输液在心搏骤停患者急救中的应用方法及效果。方法采用便利抽样法选取2017年1月至2019年1月某院急诊科收治的96例心搏骤停患者为研究对象,按治疗先后分为观察组和对照组各48例,分别行骨髓腔输液和常规静脉输液,评价并比较两组患者建立有效通道的时间、首次给药时间及输液速度等。结果全部患者均成功建立有效的输液通道;观察组患者建立有效通道所花的时间、首次给药时间等均短于对照组,差异均有统计学意义(均P<0.05);两组患者的输液速度经比较,差异无统计学意义(P>0.05)。结论与常规外周静脉输液相比,骨髓腔输液能缩短心搏骤停患者穿刺所用的时间,实现快速给药,且输液速度未见明显降低,是一种安全可靠的快速输液通道,值得临床推广应用。     

骨髓输液在有吸毒史急诊休克患者中的应用

目的:探讨骨髓输液在有吸毒史急诊休克患者中的应用效果.方法:对23例有吸毒史急诊休克患者行骨髓穿刺输液,并统计操作所用时间及常压、加压39.9 kPa情况下的输液速率,与周围静脉输液全国所用平均时间及相同情况下静脉输液平均速率对比.结果:本组操作平均用时(2.87±0.82)min,比周围静脉输液全国平均用时短,两者比较差异有统计学意义(P＜0.01);常压骨髓输液平均速率(13.66±1.58) ml/min,加压骨髓输液平均速率(41.43±3.22)ml/min,与周围静脉输液全国平均速率比较差异均无统计学意义(P＞0.05).结论:骨髓输液具有快速、高效、易操作的特点,是吸毒患者合并休克在急诊抢救早期的首选液体复苏方式.