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Viewpoint Indian Pediatrics 2001; 38: 378-380 |
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Simplified Intraosseous Needle |
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Intravenous access is difficult to obtain in an emergency, and delay in obtaining this access can compromise the effectiveness of resuscitation(1). Intraosseous cannulation provides a safe and reliable method for rapidly achieving a route for administration of drugs, fluids and blood products into a non collapsible marrow venous plexus, particularly in those six years old or younger. As per the recommendation of American Heart Association, if we don’t get venous access within three attempts or 90 seconds, then we should choose intraosseous cannulation(2). Ideally Jamshidi-type bone marrow biopsy needles are used for this purpose(3,4). However, because of non availability and high cost, there is a felt need for indigenous intraosseous needles. The following communication describes one such effort which can be readily assembled at any peripheral set up at an approximate cost of rupees fifty only.
The various constituents required for assembling the set are depicted in Table I and Fig 1. Take an 18 G disposable needle and stylet from a disposable 22G intravenous cannula. Pass the stylet into 18G needle. This stylet prevents the entry of bone pieces into the needle while advancing the needle through the bone. Then take a wire holding screw from a bulb holder (which is sterilized) and pass the screw on the needle and fix it at the base with the screw as shown in Fig. 1.
Tibial tuberosity is identified by palpation. The site of intrasosseous cannulation is approximately 1-3 cm below the tuberosity on the medial surface of the tibia. Clean the skin over the cannulation site with an antiseptic solution. Take the sterile assembled set, grasp the thigh and knee above and lateral to the cannulation site with the palm of the non-dominant hand. Insert the needle through the skin over the flat anteromedial surface of the tibia. Advance the needle through the bony cortex of the tibia directing the needle perpendicular to the long axis of the bone using gentle but firm twisting or drilling motion. A sudden decrease in resistance to insertion occurs as the needle passes through the bony cortex into the marrow. Remove the stylet from the needle and slowly inject 10 ml of normal saline through the needle. Later connect the infusion set (Fig. 2).
Stabilize the intraosseous needle by moving the wire holding screw to the skin level and tightening the screw. The screw prevents the needle from further deeper movement. Two pieces of plaster should be applied firmly on either side of the screw as shown in Fig. 3. This helps to prevent outward movement of the intraosseous needle.
Intraosseous route has life saving abilities. The introsseous needle developed in our Institute has been used on many occasions. We have found this instrument to be useful. Once the child is stabilized it is easier to get the intravenous access. However, in our experience, in one instance of refractory shock due to Dengue hemorrhagic fever, this needle was used for 36 hours. The cost of 22G, IV cannula is Rs. 30, 18G needle is Rs. 2 and a bulb holder about Rs. 10 each. Contributors: NKK devised this needle. NK helped in putting the device into use. CRB assisted in testing the device and also in drafting the paper.
Funding: None.
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