College Answer
- Identify the device depicted above
- 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