Intramedullary infusion needle rescue new weapon
Release date: 2014-08-25
Rapid rescue of vascular access is a necessary step in the rescue of critically ill patients. However, in some cases, it is difficult to establish a central venous access or peripheral vascular access in a timely and effective manner, especially in children, newborns, and some adult patients with vasoconstriction or sclerosis. An intramedullary infusion needle is thus produced.
The medullary cavity has a highly differentiated vascular structure that can be considered as a fixed vein for high-dose fluids and drug infusions, and can be quickly accessed into the central circulation. The intramedullary vascular sinus merges into the central vein in the form of a guiding vein and a nutrient vein. The size of the medullary cavity and the diameter of the intramedullary infusion needle directly affect the infusion rate.
Indications for intramedullary infusion needle rehydration are urgently needed for rehydration or drug therapy via vascular access but not for routine venous access. Cardiac arrest, shock, trauma, extensive burns, severe dehydration, and persistent epilepsy are clinical cases in which intramedullary infusion needles may be used. Intramedullary infusion needles can often be successfully used in the treatment of venous access due to environmental factors.
Almost all drugs used in conventional routes can achieve therapeutic effects at the same dose via the intramedullary route - including crystalloids, colloidal fluids, blood products, and pharmaceutical ingredients such as vasopressin. At the same time, intramedullary infusion needles can provide timely clinical intramedullary samples to clinical laboratories for the diagnosis of critically ill patients.
Adult patients have multiple locations for intramedullary infusion needles, such as the proximal humerus, distal radius, humerus, femur, sternum, calcaneus, and sacral styloid processes.
In a certain sense, placing an intramedullary infusion needle is an expedient measure when other vascular access methods cannot work. Intramedullary infusion needle retention time is 72 to 96 hours. If other vascular access has been established, it is recommended to remove the intramedullary infusion needle within 6 to 12 hours.
In conclusion, intramedullary infusion needles provide a fast and effective method of infusion for emergency treatment. Reasonable application and technical support can improve the safety and effectiveness of intramedullary infusion needles. (dock frost down compilation)
Comment
Best for outpatient first aid
Commentator: Li Wenxiong, Director of SICU, Beijing Chaoyang Hospital, Capital Medical University
The New England Journal of Medicine published the above review in June this year to introduce adult intramedullary needle insertion techniques. The article describes the basic principles, indications, contraindications and surgical complications of intramedullary infusion needle rehydration, and focuses on the choice of puncture position and two puncture methods. For the evaluation of an emergency drug delivery route, it should be considered whether the pathway is simple and rapid, and whether the drug delivery effect is exact.
Intramedullary infusion needles were first used in children's rescue and resuscitation. With the application of mechanically assisted devices, their operation is increasingly fast and simple, and can also be applied to adults. At present, intramedullary infusion needle rehydration is mainly used for patients whose vascular access is difficult to establish. This situation often occurs in the out-of-hospital rescue process, because some environmental factors affect the establishment of peripheral venous access, and the establishment of central venous access to the professional technical requirements of the operator. Higher, it is also difficult to implement outside the hospital. In the case of limited rescue conditions outside the hospital, the application of mechanically assisted placement equipment makes the establishment of intramedullary needles easier and faster, and strives for time for rescue medication. There are some contraindications for intramedullary needle aspiration, including ipsilateral fractures at the infusion end, local vascular injury at the infusion end, cellulitis or burns, which limits its use in trauma first aid. In addition, in the emergency or ICU ward, bedside ultrasound-guided central venous catheterization is rapid and accurate, with a high success rate, and can also monitor central venous pressure and test blood samples. Therefore, the establishment of central venous access is still the first choice for the replacement of intramedullary needles when resuscitating patients with severe acute illness in the hospital.
The medullary cavity has a highly differentiated vascular structure, and large doses of liquid and drugs can quickly enter the central circulation through this infusion, so the administration effect is reliable. However, the size of the medullary cavity and the diameter of the intramedullary infusion needle directly affect the infusion rate. Most critically ill patients require fluid resuscitation, which requires high fluid infusion rate. Therefore, it is not a good thing to establish intramedullary infusion needles. Active venous access should also be established to ensure patients can get more precise treatment. Once an exact and effective venous access is established, consideration should be given to removing the intramedullary needle in time to avoid osteomyelitis.
Intramedullary needle infusion is an emergency method. It is the first to use emergency first aid for limited rescue conditions, and secondly for patients who cannot quickly establish venous access during hospital emergency. Because intramedullary needle infusion has the unique advantages of simplicity, speed and reliability, it is worth promoting in hospitals.
Source: Health News
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