Sunday, July 25, 2010

Intraosseous access...

After the nurses’ workshop on Monday I passed through the Emergency Room and noticed two of the doctors hovering over a nine-month-old child. They were attempting to get intravenous access. Like in many of the emergency cases, this child’s circulation was poor. While one doctor was attempting jugular access, I suggested inserting an intraosseous needle.

Having experience, albeit a year ago when I was last in Sierra Leone in the outpatient setting, I was handed a standard 19-gauge needle and attempted to get access into the tibia of the left leg. Using some force and a screwing motion I felt the needle push through the bone and within a minute or two the needle was in place. I quickly withdrew some bone marrow content confirming the needle was in the cavity. I then flushed the needle with normal saline to reconfirm the position. Thankfully, a few seconds later the child received dextrose and a normal saline bolus through the needle in the tibia. What a relief.

Now, I could only hope that the insertion of the needle had saved this child’s life. Since his condition on arrival was very poor, only time would tell what the outcome would be.

I checked up on the child every day to assess his condition and was glad to see a little bit of improvement each time I saw him. On Tuesday he was transferred from the Emergency Room to the Intensive Care Ward and on Thursday, after some searching, I finally found the child up in Ward 3. His grandmother was looking after him the whole time.

Finally, 8 days after I saw him initially, he was discharged. His condition was stable and he was looking much better. His grandmother was very happy to be able to take him home and I am hoping for ongoing recovery for him.

So, in conclusion, intraosseous access did save this child’s life and I think it is a procedure that should be done more often. It is actually not a difficult procedure to perform and as long as a sterile environment is created, the doctor is fairly confident and a large bore needle is available, it can be done within a few minutes. The chance of complications is very small if a proper (sterile) technique is used and as long as the needle is removed after a few hours. The benefits far outweigh the risks and in an emergency setting it is an ideal way of ensuring a quick delivery of fluids, blood and medication. I am definitely in favor of intraosseous access. INTRAOSSEOUS ACCESS SAVES LIVES.

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