Burgert James M
US Army Graduate Program in Anesthesia Nursing, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
AANA J. 2009 Oct;77(5):359-63.
A 79-year-old woman presented in the postanesthesia care unit with hematemesis following replacement of a jejunostomy tube. Her medical history included recurrent stage IIIC ovarian cancer. The patient rapidly decompensated despite blood products administered through the patient's implanted medication port. The anesthesia service was consulted for resuscitative support. Examination revealed an alert, hypotensive elderly female in hemorrhagic shock. While peripheral intravenous (IV) access was sought, her condition further deteriorated. Attempts at peripheral access were determined futile and central venous access would be required. An intraosseous (IO) catheter was placed in the proximal medial aspect of the left tibia using the EZ-IO device (Vidacare Corp, San Antonio, Texas). Crystalloid and colloid fluids, blood products, and drugs were administered via the IO route, stabilizing the patient's condition during the central access procedure. The IO route was used throughout the resuscitative effort. Hemostasis was achieved, and the patient was admitted to the intensive care unit. Intraosseous infusion is a valuable and underutilized technique in managing patients in hemorrhagic shock with poor IV access. Anesthesia providers should seek education and training from those experienced in IO placement techniques and consider use of the IO route early in the resuscitative process.
一名79岁女性在空肠造口管更换后于麻醉后护理单元出现呕血。她的病史包括复发性IIIC期卵巢癌。尽管通过患者植入的给药端口输注了血液制品，但患者病情迅速恶化。咨询麻醉科以寻求复苏支持。检查发现一名处于失血性休克的警觉、低血压老年女性。在寻找外周静脉通路时，她的病情进一步恶化。确定外周穿刺失败，需要建立中心静脉通路。使用EZ-IO装置（Vidacare公司，得克萨斯州圣安东尼奥）在左胫骨近端内侧置入骨内（IO）导管。晶体液、胶体液、血液制品和药物通过IO途径给药，在建立中心静脉通路过程中稳定了患者的病情。在整个复苏过程中都使用了IO途径。出血得到控制，患者被收入重症监护病房。骨内输液在处理外周静脉通路不佳的失血性休克患者中是一种有价值但未得到充分利用的技术。麻醉医护人员应向有骨内置管技术经验的人员寻求教育和培训，并在复苏过程早期考虑使用IO途径。
