intraosseous

• adj.

• 骨内の、骨髄内、骨髄の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/01/26 20:11:49」(JST)

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Intraosseous infusion
Intervention
Two pictures of the EZ IO device.
eMedicine	80431

Intraosseous infusion (IO) is the process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system. This technique is used to provide fluids and medication when intravenous access is not available or not feasible. A comparison of intravenous (IV), intramuscular (IM), and intraosseous (IO) routes of administration concluded that the intraosseous route is demonstrably superior to intramuscular and comparable to intravenous administration (in delivering paediatric anaesthetic drugs). This route of fluid and medication administration is an alternative one to the preferred intravascular route when the latter cannot be established in a timely manner

Effectiveness

This American Heart Association guideline cited two randomized controlled trials, one of 60 children and one of electively cannulated hematology/oncology patients. In addition, uncontrolled studies have been performed, one of which reported 72% to 87% rates of successful insertion.

Procedure

NIO IO device

BIG IO devices

Axial CT with left humeral head EZ IO infusion of contrast.

The needle is injected through the bone's hard cortex and into the soft marrow interior which allows immediate access to the vascular system. An IO infusion can be used on adult or pediatric patients when traditional methods of vascular access are difficult or otherwise cause unwanted delayed management of the administration of medications. Each IO device has different designed locations, but the most common site of insertion is the the antero-medial aspect of the upper, proximal tibia as it lies just under the skin and can easily be palpated and located. The anterior aspect of the femur, the superior iliac crest and the head of the humerus are other sites that can be used. The IO needle is then positioned at a 90 degree angle to the injection site, and the needle is advanced through manual traction, impact driven force, or power driven. The site of injection can be maintained for 24–72 hours, after which another route of access should be obtained to prevent the risk of an infection at the site.

Intraosseous infusion is contraindicated when there is a possibility that the potential site of injection has a known, or suspected fracture, appears to be visibly infected, or is burned. Medical conditions that might also preclude the use of intraosseous infusion include osteopenia, osteopetrosis, and osteogenesis imperfecta as fractures are more likely to occur. The procedure also only allows for one attempt per bone meaning another route of infusion much be secured, or a different bone chosen.

Although intravascular access is still the preferred method for medication delivery in the prehospital area, IO access for adults has become more common. As of 2010, American Heart Association no longer recommends using the endotracheal tube for resuscitation drugs, except as a last resort when IV or IO access cannot be gained. The IO is becoming more and more common in civilian and military based pre-hospital emergency medical services (EMS) systems around the world. Intraosseous access has roughly the same absorption rate as IV access, and allows for fluid resuscitation as well as high-volume drugs such as sodium bicarbonate to be administered in the setting of a cardiac arrest when IV access is unavailable. Endotracheal administration allows only specific drugs that have relatively low toxicity to lung tissue, and must be restricted to relatively low volumes to avoid drowning the patient.

Devices

The automatic intra-osseous devices allow quick and safe access to the patient's vascular system for fluid and drug administration. There are several FDA approved IO devices: The BIG Bone Injection Gun and The NIO New Intra Osseous device are automatic intra-osseous infusion device used by military and civilian healthcare systems; the battery-powered EZ-IO and hand-powered Fast1, Fast Combat and Fast Responder. Other devices include the Cook IO needle and the Jamshidi 15G.

There have been several studies comparing the EZ-IO and the BIG. Another paper compared the EZ-IO with the Cook IO needle.

References

External links

• MeSH E05.300.510.560

UpToDate Contents

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• 1. 骨髄内投与 intraosseous infusion
• 2. 成人における確定診断を得られていない低血圧やショックの評価および初期アプローチ evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock
• 3. 超音波ガイド下血管アクセスの原則 principles of ultrasound guided venous access
• 4. Klippel-Trenaunay syndrome: Clinical manifestations, diagnosis, and management
• 5. 成人における選択的脊椎手術のための麻酔 anesthesia for elective spine surgery in adults

English Journal

• Intraosseous access in neonates and infants: risk of severe complications - a case report.

• Suominen PK1, Nurmi E1, Lauerma K2.
• Acta anaesthesiologica Scandinavica.Acta Anaesthesiol Scand.2015 Nov;59(10):1389-93. doi: 10.1111/aas.12602. Epub 2015 Aug 24.
• Gaining vascular access in a neonate during cardiopulmonary resuscitation is crucial and challenging. Intraosseous (IO) access can offer a fast and reliable method for achieving emergency access for fluids and drugs when venous access fails in a critically ill child. IO access can however result in
• PMID 26300243

• CORR Insights(®): Regional Intraosseous Administration of Prophylactic Antibiotics is More Effective Than Systemic Administration in a Mouse Model of TKA.

• Zalavras CG1.
• Clinical orthopaedics and related research.Clin Orthop Relat Res.2015 Nov;473(11):3585-7. doi: 10.1007/s11999-015-4521-5. Epub 2015 Aug 21.
• PMID 26293224

• Regional Intraosseous Administration of Prophylactic Antibiotics is More Effective Than Systemic Administration in a Mouse Model of TKA.

• Young SW1,2, Roberts T3, Johnson S4, Dalton JP4,5, Coleman B3, Wiles S4,5.
• Clinical orthopaedics and related research.Clin Orthop Relat Res.2015 Nov;473(11):3573-84. doi: 10.1007/s11999-015-4464-x. Epub 2015 Jul 30.
• BACKGROUND: In human TKA studies, intraosseous regional administration (IORA) of prophylactic antibiotics achieves local tissue antibiotic concentrations 10 times greater than systemic administration. However, it is unclear if such high concentrations provide more effective prophylaxis.QUESTIONS/PUR
• PMID 26224291

Japanese Journal

• 新規イメージング法による骨内血管網-骨基質異方性構造の相関解明

• 日本金属学会誌 = Journal of the Japan Institute of Metals and Materials 81(6), 315-319, 2017-06
• NAID 40021230095

• 臨床報告 眼窩骨に生じた海綿状血管腫の1例

• 眼科 59(4), 443-447, 2017-04
• NAID 40021196143

• A rare case of multiple phosphaturic mesenchymal tumors along a tendon sheath inducing osteomalacia

• BMC musculoskeletal disorders 18, 79, 2017-02-13
• NAID 120006219944

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★リンクテーブル★

リンク元	「IO」
拡張検索	「intraosseous ganglion」

「IO」

　　[★]

• intraosseous 骨髄内、骨髄の

「intraosseous ganglion」

　　[★]

骨内ガングリオン

関

bone cyst、solitary cyst、subchondral cyst