Bone marrow cavity infusion

Simply put, intraosseous infusion is the injection of the liquid needed by the human body directly into the bone marrow cavity. This situation is mostly used in emergency situations and is still in clinical use. This method is not only safe but also relatively fast. It can get people treated in a very short time. It is a very popular treatment method, but many people may not be particularly familiar with intraosseous infusion.

Intraosseous Infusion (IO) is an emergency infusion method established under special circumstances. It uses the rich vascular network in the marrow cavity of long bones to infuse drugs and fluids into the blood circulation through the marrow cavity. It is not widely used in China at present. When venous access cannot be established, IO is the only, safest and most convenient way to establish a "life channel", effectively avoiding the shortcomings of peripheral venous access, such as intolerance of irritating drugs, easy fall-off of puncture needles, difficulty in establishing venous access due to vascular collapse, and high technical requirements and costs of deep vein puncture, as well as many potential dangers.

1 Principle of intraosseous infusion

The medullary cavity is composed of a network of cavernous sinusoids, which are connected to the blood circulation through the central canal, nutrient veins and emissary veins. Therefore, drugs and fluids injected into the bone marrow cavity can enter the blood circulation quickly and effectively. The bone marrow cavity is surrounded by bony structures and does not collapse due to insufficient blood volume like the vascular cavity. When the peripheral veins collapse, the intraosseous venous channels remain open and have greater permeability, which provides an anatomical basis for intramedullary drug infusion. In addition, the pharmacokinetics, pharmacodynamics and dosage of drugs infused through this route are very similar to those administered via peripheral vascular administration. Drugs that can be used intravenously can also be used intraosseously. Currently, there are no reports of contraindications to intraosseous administration.

2.1 Indications

The bone marrow cavity is considered to be a never-collapse blood vessel that is filled with bone marrow and connected to the body's blood circulation. It will not collapse or be damaged even in a state of shock.

The IO approach is suitable for critically ill patients of any age when intravenous access is not possible or cannot be established quickly and timely. For example, cardiac arrest, shock, sepsis, severe trauma, extensive burns, status epilepticus, etc. may require immediate infusion of drugs, fluids, and blood products, and establishing intravenous or IO access is particularly important. For some obese patients, IO should also be considered in emergency situations if venous access fails.

2.2 Contraindications

Contraindications include fractured bones, patients with osteogenesis imperfecta, patients with severe osteoporosis, and patients with cellulitis at the puncture site.

2.3 Complications

Complications after successful IO puncture are rare and are mainly related to the puncture technique. Extravasation of blood, drugs, and fluids into the surrounding soft tissues is the most common complication. In severe cases, compartment syndrome may occur. The most serious complication is osteomyelitis caused by prolonged infusion.

3. Puncture site and method

Foreign studies have shown that the proximal and distal tibia, distal femur, proximal humerus and clavicle, etc., as long as they can enter the bone marrow cavity, can be used as puncture sites. According to the literature reports in my country, the tibia, ilium, sternum, etc. are the main puncture sites. In my country, bone marrow cavity infusion mainly uses bone marrow puncture needles, injection needles, etc. For children, scalp puncture needles No. 7 to 9 are also used directly. The puncture point is about 2 cm below the inner side of the patient's tibial tuberosity. After comprehensive disinfection, local anesthesia needs to be given in time. The anesthetic drug is 3 mL of lidocaine with a concentration of 2%. Different types of bone marrow puncture needles need to be selected for the patient based on the patient's body shape and age. The needle insertion angle needs to be 60 ~ 90° with the patient's backbone, and the needle insertion direction is to pierce outward and downward. During this process, if you feel a clear sense of emptiness, you need to pull out the needle core in time, and then use a syringe to extract the local bone marrow. Then you can connect the infusion device in time, and use rescue drugs to give the patient infusion treatment, and it needs to be properly bandaged and fixed.

4 Outlook for intraosseous infusion

Bone marrow cavity infusion can be widely used in non-medical institutions and primary medical stations due to its fixed anatomical position, clear landmarks, high puncture success rate, simple method and fast operation speed. Especially when venous puncture is difficult or

When there are taboos, the bone marrow cavity becomes the safest and most convenient "life passage". The clinical application of intraosseous intramuscular infusion in hospitals and pre-hospital settings has been recognized worldwide and will surely play an increasingly important role.