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Intraosseous Infusions

Working in a hospital emergency room provides plenty of opportunities to see some amazing things. I’ve seen nurses place IVs into patients necks. Oddly, if I saw this in a movie, I would be squirming in my seat (see Permanent Midnight for an example of this, or not if you’re so disinclined), but while watching in real life, all I can think about is how cool it is that I get to actually see it being done.

Last week I got to see something that I had never even thought was possible, let alone got to see. A patient was brought in with severe blood loss, medics had tried but couldn’t get an IV into him.  To get the patient necessary fluids, the nurses gave him an intraosseous infusion. To paraphrase Lyle Lanley, Osseous means bone and intra means intra. Instead of giving fluid through the vein, they jabbed a needle (a giant freakin needle) into the bone marrow, and administered fluids that way. So instead of the normal tubing coming out of his arms, there was tubing leading to sockets in his shin bones. The IV fluid would go through the bone marrow, get picked up by veins coming out of the bone and reach the heart that way.

Despite never having heard of this before, it’s a technique that was discovered in the 30s. A couple of scientists (Tocantins and O’Neill) found that if they injected a dye into the long bone of a rabbit, within ten seconds the dye made its why to the heart. It was the first time that anyone realized that a liquid injected into bone would enter the circulatory system.

After some refining of the technique, they found that intraosseous infusions would be an easy and effective way to get fluids and medicine to those who critically needed it. Thank goodness they did, too because the technique was used by army medics during World War II. The reason that I had never seen it done before is because most people have enough blood to make IV access the best option, even if it takes quite a while. However, if you need to get someone fluids extrememly fast and can’t get IV access, this is the best option. It’s still used in combat situations. There’s a device called FAST1 which takes a lot of the danger and guesswork out of the procedure.

Scarily enough, the FAST1 is designed to be used in the sternum. That’s right, in true Pulp Fiction style, they inject something right into your freakin chest. The reason the sternum is the best site to go is because it has a uniform thickness in people. No matter what your body type, the width is going to be the same. The FAST1, when activated finds the top layer of the bone and inserts the needle a specific distance into the marrow. This way, one device works on everyone.

It’s also safe to use. So safe that army medics practice using it on each other. Despite looking freaky as hell, it also appears to be relatively painless. And by that, I mean it’s not going to cause the patient to jump up screaming in terror.

There’s also a really cool demonstration of how the dye works its way into the circulatory system.

In a normal, non-combat setting, intraosseous infusion is mostly used in pediatric patients, whose veins are hard to access to begin with, and if they’re sick and dehydrated it can make access impossible. However it’s only a temporary option, which should be left in for a few hours, until the patient can be better hydrated and intravenous options can be accessed.

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Categories: Science
  1. July 1, 2010 at 7:12 pm

    Oh my God, that video of the guy sticking the needle in the other guy’s chest freaked me out. Even if it is relatively safe, I don’t think I’d let someone practice that sort of thing on me. I don’t want needles anywhere near my chest, unless there’s some sort of emergency and I need it.

  2. Jonmedic101
    July 7, 2010 at 12:17 am

    yea Jenny i totally understand you……
    i don’t think intraosseous is a procedure to practice on someone alert anyway…..
    what kind of device for intraosseous do you use?

    • DJ
      July 10, 2010 at 7:33 am

      I’m not sure what they use at the hospital. I was never able to see them put one in, just saw what the port looked like after it was in.

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