Agulhas Intra-

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Objectives of this presentation

• Historical background of intraosseous (I.O.)
  infusion.
• The anatomical and physiological principle of
  I.O. infusion.
• Familiarization with the B.I.G.
• Indications for I.O. infusion.
• Technique of insertion.
• Medications and fluids.
• Questions.

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Historical background of I.O. infusions

• First described by Drinker et al., in 1922.
• In 1941, the method was introduced for clinical
  use by Tocantis et al., mainly in children.
• Bailey et al. described cannulation of the
  sternum in 1946.
• Intraosseal regional anesthesia is described by
  Thorn-Alquist in 1971.
• 2000, recommended for use in the emergency
  setting by ILCOR.

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The anatomical and physiological principle of
I.O. infusion
Utilizes the the emissary veins that lead from
the intramedullary cavity to the general
circulation.
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Anatomy of long bones, another look
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I.O. infusions, what has been available until
today?
Manually inserted hand held infusion needles have
been available for a number of years.

• Have required a great deal of skill and
  experience.
• Are not reliable.
• Difficult to use.
• Often not used by medical personnel due to
  associated psychological barriers.

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Introducing the B.I.G
Adult B.I.G - 15G CE FDA Approved
Pediatric B.I.G - 18G CE Approved
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Design of the B.I.G

• Developed to be easily used by a single rescuer.
• Allows immediate vascular access.
• Permits the rapid infusion of medications and
  fluids.
• Minimizes exposure to the patients bodily
  fluids.
• Can be successfully used by physicians and
  paramedics.

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Design of the B.I.G
Instrument in locked position (before triggering).
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Design of the B.I.G
After triggering.
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Indications for I.O. infusions

1. TRAUMA

• Fluid replacement in shock.
• Rapid vascular access during mass casualty
  incidents.

1. NON-TRAUMA

• All cardiac arrests.
• Acute respiratory syndromes (COPD, Asthma, APE).
• When ever rapid vascular access is required.

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FROM THE ECC GUIDELINES 2000 Rescuers should
increase attention to early vascular access,
including immediate Intraosseous access for
victims of cardiac arrest, and extend the use of
Intraosseous techniques to victims gt6 years
ECC Guidelines 2000 Pediatric Advanced Life
Support
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When You Might Need I.O.
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How It Works
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Insertion Technique Recommended trocar needle
penetration depths
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Insertion Technique Adults
Find Mark penetration site
2 cm medially and 1 cm proximally to the tibial
tuberosity
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Insertion Technique Pediatrics
Find Mark penetration site
Age 0-6 1 cm medially and 1 cm proximally To
the tibial tuberosity
Age 6-12 1-2 cm medially and 1-2 cm proximally
To the tibial tuberosity
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Insertion Technique
Position the BIG with one hand to the site and
pull out the Safety Latch with the other hand.
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Insertion Technique
Trigger the BIG at 90 to the surface.
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Insertion Technique
Remove the BIG.
Pull out the stylet trocar.
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Insertion Technique
Connect IV Set with a stopcock Adults flush
with 1mg/ kg for I.O. local anesthetics.
Fix the cannula with the Safety Latch.
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Insertion Technique
Now 2 5 cc of bone marrow can be aspirated into
a heparin-coated syringe for laboratory sampling,
or proceed to inject medications or infuse
fluids. To maintain optimal flow, high
pressure, up to 300 mmHg to the infusion bag may
be necessary.
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Insertion Technique Recommended insertion sites
Anatomical insertion point of the tibial
tuberosity.
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Medications and fluids

• All medications and fluids can be safely
  injected into the B.I.G.
• I.O. medication and fluid boluses remain the
  same as those for I.V. injection.
• It is not recommended that large boluses of
  hypertonic solutions be infused through the I.O.
  cannula.
• In case of user inaccuracy, or technical
  malfunction, it is strongly recommended to always
  have a second B.I.G. On hand.

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Questions?
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Thank you.
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