Reuter-Rice Karin, Patrick Dana, Kantor Elizabeth, Nolin Cathy, Foley Jennifer
School of Nursing, Duke University, and School of Medicine, Department of Pediatrics, Duke Institute for Brain Science, Durham, North Carolina (Dr Reuter-Rice); Division of Pediatric Critical Care (Ms Foley), Rady Children's Hospital, San Diego, San Diego, California (Mss Patrick, Kantor, and Nolin); and PICU-CHET Team, San Diego, California (Mss Kantor and Nolin).
Adv Emerg Nurs J. 2015 Oct-Dec;37(4):301-7. doi: 10.1097/TME.0000000000000077.
Intraosseous (IO) access is a standard of care for pediatric emergencies in the absence of conventional intravenous access. Intraosseous needles provide access for resuscitation fluids and medications and are often placed in the emergency department. However, there are no studies to date that describe the characteristics of pediatric IO needle recipients or their dispositions and outcomes. This study examined the characteristics and disposition of children following IO needle placement by prehospital and emergency room teams before being transported to a children's hospital. We conducted a retrospective descriptive analysis of pediatric patients who had an IO needle placed as a part of their transport care. Data was extracted from a Level 1 trauma tertiary care children's hospital transport database from 1993 to 2009. We measured diagnosis, insertion reason, insertion time (day vs. night shift), complications, and disposition of patients after IO needle placement. There were 143 eligible patients in the study; 65% were males. Mean patient's age was 1.2 years (range: 0.01-13 years). Intraosseous needles were placed most often for patients with cardiopulmonary compromise. Of the 143 patients transported, 53% (n = 76) were placed for no intravenous access and 34% (n = 49) were placed for nonperfusing rhythm. The majority of the IO needles were placed during the daytime (0700-1900 hr), and most patients experienced no complications (n = 67; 47%). However, of those who experienced a complication, 27% were due to infiltration of the IO needle. Of those admitted to hospital, 58% (n = 83) were ultimately discharged home. Intraosseous access provides a safe and reliable method for rapidly achieving a route for administration of medications, fluids and blood products. It is a lifesaving measure with most IO needles successfully placed by referring facilities prior to transport, with few reported complications.
在无法进行传统静脉通路穿刺时，骨内（IO）通路是儿科急诊的一项护理标准。骨内针可为复苏液体和药物提供通路，且常在急诊科放置。然而，迄今为止尚无研究描述接受骨内针穿刺的儿科患者的特征、处置情况及结局。本研究调查了在被转运至儿童医院之前，由院前和急诊室团队为儿童放置骨内针后的特征及处置情况。我们对作为转运护理一部分而接受骨内针穿刺的儿科患者进行了回顾性描述性分析。数据取自1993年至2009年一家一级创伤三级护理儿童医院的转运数据库。我们测量了患者骨内针穿刺后的诊断、穿刺原因、穿刺时间（白班与夜班）、并发症及处置情况。本研究中有143例符合条件的患者；65%为男性。患者平均年龄为1.2岁（范围：0.01 - 13岁）。骨内针最常用于有心肺功能不全的患者。在143例被转运的患者中，53%（n = 76）因无法建立静脉通路而放置骨内针，34%（n = 49）因无灌注心律而放置。大多数骨内针在白天（0700 - 1900时）放置，且大多数患者未出现并发症（n = 67；47%）。然而，在出现并发症的患者中，27%是由于骨内针渗漏。在入院的患者中，58%（n = 83）最终出院回家。骨内通路为快速建立给药、输液及输血制品的途径提供了一种安全可靠的方法。这是一项挽救生命的措施，大多数骨内针由转诊机构在转运前成功放置，报告的并发症很少。
