• Identify the device depicted above
  • List the indications for use of this device
  • List the potential complications associated with the use of this device.

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College Answer

  • Identify the device depicted above
    • Intra-osseous needle
  • List the indications for use of this device
    • Difficulty in establishing IV access
    • Need for rapid high-volume fluid infusion eg hypovolaemic shock or burns, and failure to establish IV access
    • Cardio-pulmonary arrest
  • List the potential complications associated with the use of this device
    • Infection – cellulitis and osteomyelitis
    • Extravasation of blood / infusion fluid / drugs
    • Compartment syndrome secondary to extravasation
    • Bone fracture or through and through penetration
    • Damage to surrounding structures

Discussion

This question is very similar to Question 10 from the first paper of 2000: "List your indications and contraindications for the use of the lntraosseous needle. What are the risks associated with its use and how can they be minimised? "

The college-specified indications for the use of the intraosseous needle are difficult to expand upon. There is little to say!

  • Cardiac arrest
  • Need for immediate IV access in the absence of easy IV access

Complications

  • Osteomyelitis
  • Fracture
  • "through and through" penetration
  • Extravasation
  • Compartment syndrome due to extravasation
  • Injury to staff (slipped needle)
  • Damage to surrounding structures
  • Microscopic fat emboli

With sternal approach:

  • Mediastinal injury
  • pneumothorax
  • Greater vessel injury

References

References

Luck, Raemma P., Christopher Haines, and Colette C. Mull. "Intraosseous access." The Journal of emergency medicine 39.4 (2010): 468-475.