VENÖZ ERİŞİME BİR KÖPRÜ: İNTRAOSSEÖZ GİRİŞİM

Öz

İntraosseöz girişim ilaç, kan ve sıvıların doğrudan kemik içindeki medüller boşluğa verilerek, venöz damar ağı ile dolaşıma katılmasını sağlayan bir yöntemdir. Bu yöntem, kritik hastalar için, hayat kurtarıcı tedavilerin hızlı uygulanmasına olanak tanımasının yanı sıra, kısa süreli venöz erişim ihtiyacını karşılamak üzere bir köprü görevi de üstlenmektedir. Tıp alanındaki teknolojik gelişmelerle birlikte, inraosseöz girişimin uygulanması daha da kolaylaşmış, yerleştirme başarısızlığı ve olası komplikasyonlar önemli ölçüde azalmıştır. Bu sayede acil durumlarda intravenöz erişim sağlanamadığında, sadece pediatrik hastalarda değil, aynı zamanda yetişkinlerde de inraosseöz yolun tercih edilmesi giderek yaygınlaşmaktadır. Ancak, mevcut durumda inraosseöz girişimin potansiyeli yeterince değerlendirilmemektedir. Bu derleme, güncel literatürdeki bilgileri inceleyerek inraosseöz girişimin anatomik ve fizyolojik temelleri ile işleyiş mekanizması, endikasyonları, uygulama sürecine ilişkin ayrıntılar ve komplikasyonları hakkında kapsamlı bir bilgi sunmayı amaçlamaktadır. Sağlık profesyonelleri için bir rehberlik kaynağı oluşturarak, bu önemli yöntemin daha geniş bir şekilde anlaşılmasına katkıda bulunmayı hedeflemektedir.

Anahtar Kelimeler

• İntraosseöz Girişim
• Acil Durum
• Travma
• Resüsitasyon
• İntravenöz

A BRİDGE TO VENOUS INTERVENTION: INTRAOSSEOUS ACCESS

Öz

Intraosseous access is a method that allows drugs, blood and fluids to be administered directly into the medullary cavity within the bone and circulated through the venous vascular network. For critically ill patients, this method not only allows for the rapid administration of life-saving treatments, but also acts as a bridge to meet the need for short-term venous intervention. With technological advances in the medical field, intraosseous access has become easier to perform and placement failure and potential complications have been significantly reduced. Thus, when intravenous access is not available in emergency situations, the intraosseous route is increasingly preferred not only in pediatric patients but also in adults. However, the potential of intraosseous access is currently underutilized. This review aims to provide comprehensive information on the anatomical and physiologic basis of intraosseous access, its mechanism of action, indications, details of the procedure and complications by reviewing the current literature. It aims to contribute to a broader understanding of this important procedure by providing a source of guidance for healthcare professionals.

Anahtar Kelimeler

• Intraosseous Access
• Emergency
• Trauma
• Resuscitation
• Intravenous

Kaynakça

1. Astasio-Picado, A, Cobos-Moreno, P, Gomez-Martin, B, del Carmen Zabala-Banos, M, Aranda-Martin, C. (2022). Clinical Management of Intraosseous Access in Adults in Critical Situations for Health Professionals. Healthcare, 10(2), 367.
2. Atmaca, MO. (2022). Humerus Proximal Uçtan Yapılan İntraosseöz Yol Uygulamasında Güvenli Alan Belirlenmesine Yönelik Radyoanatomik Çalışma. Ankara Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı Uzmanlık Tezi. Ankara.
3. Baert, V, Vilhelm, C, Escutnaire, J, Nave, S, Hugenschmitt, D, Chouihed, T, et al. (2020). Intraosseous Versus Peripheral Intravenous Access During Out-of-Hospital Cardiac Arrest: A Comparison of 30-Day Survival and Neurological Outcome in the French National Registry. Cardiovascular Drugs and Therapy, 34(2), 189-197.
4. Bouhamdan, J, Polsinelli, G, Akers, KG, Paxton, JH. (2022). A Systematic Review of Complications from Pediatric Intraosseous Cannulation. Current Emergency And Hospital Medicine Reports.
5. Brebner, C, Asamoah-Boaheng, M, Zaidel, B, Yap, J, Scheuermeyer, F, Mok, V, et al. (2023). The association of tibial vs. Humeral intraosseous vascular access with patient outcomes in adult out-of-hospital cardiac arrests. Resuscitation, 193, 110031.
6. Buck, ML, Wiggins, BS, Sesler, JM. (2007). Intraosseous drug administration in children and adults during cardiopulmonary resuscitation. The Annals of Pharmacotherapy, 41(10), 1679-1686.
7. Cicolini, G, Comparcini, D, Simonetti, V, Maria Papappicco, CA, Unsworth, J, Tomietto, M. (2023). Nurses’ knowledge and self-assessment of their clinical experiences of intraosseous access: A multicentre cross-sectional study. International Emergency Nursing, 69, 101314.
8. Dornhofer, P, Kellar, JZ. (2023). Intraosseous Vascular Access. Içinde StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK554373/

9. Drozd, A, Wolska, M, Szarpak, L. (2021). Intraosseous vascular access in emergency and trauma settings: A comparison of the most universally used intraosseous devices. Expert Review of Medical Devices, 18(9), 855-864.
10. Elliott, A, Dubé, PA, Cossette-Côté, A, Patakfalvi, L, Villeneuve, E, Morris, M, et al. (2017). Intraosseous administration of antidotes: A systematic review. Clinical Toxicology (Philadelphia, Pa.), 55(10), 1025-1054.
11. Garside, J, Prescott, S, Shaw, S. (2016). Intraosseous vascular access in critically ill adults—A review of the literature. Nursing in Critical Care, 21(3), 167-177.
12. Group, CTR, Gehrz, WJ, Emerling, A, Kay, V, Reilly, E, Young, R, et al. (2021). 43 The Importance of Intraosseous Placement Location on Infusion Rates and Infusion Pressures in a High Bone Density Humerus and Sternum Cadaveric Swine (Sus Scrofa) Model. Annals of Emergency Medicine, 78(4), S18-S19.
13. Hallas, P, Brabrand, M, Folkestad, L. (2012). Reasons for not using intraosseous access in critical illness. Emergency Medicine Journal, 29(6), 506-507.
14. Hoskins, M, Sefick, S, Zurca, AD, Walter, V, Thomas, NJ, Krawiec, C. (2022). Current utilization of interosseous access in pediatrics: A population-based analysis using an EHR database, TriNetX. International Journal of Emergency Medicine, 15(1), 65.
15. İpek Çelen, Ö. (2022). Sıvı Tedavisi ve İlaç Uygulamaları: İntraosseoz Uygulama. Editörler Gürkan Özel, Betül Akbuğa Özel, Mehmet Ergin. Paramedik. 2. Baskı. Güneş Tıp Kitabevleri. Ankara. ss: 735-744.
16. Josefson, A. (1934). A new method of treatmentintraossal injections. Acta Medica Scandinavica, 81, 550-564.
17. Jousi, M, Laukkanen-Nevala, P, Nurmi, J. (2019). Analysing blood from intraosseous access: A systematic review. European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine, 26(2), 77-85.
18. Lange, P, Umar, M, Walker, JD, Riddle, M, Mochmer, P. (2022). Evaluation of the NIO and TALON Intraosseous Devices as Placed by U.S. Army Conventional Force Combat Medics: A Randomized Crossover Study. Military Medicine, 187(7-8), e877-e881.
19. Lewis, P, Wright, C. (2015). Saving the critically injured trauma patient: A retrospective analysis of 1000 uses of intraosseous access. Emergency Medicine Journal: EMJ, 32(6), 463-467.
20. Michael, S. (2013). Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 1: Local anaesthetics in intraosseous access. Emergency Medicine Journal, 30(5), 423-424.
21. Miller, LJ, Philbeck, TE, Montez, D, Spadaccini, CJ. (2010). A new study of intraosseous blood for laboratory analysis. Archives of Pathology & Laboratory Medicine, 134(9), 1253-1260.
22. Palazzolo, A, Akers, KG, Paxton, JH. (2023). Complications of Intraosseous Catheterization in Adult Patients: A Review of the Literature. Current Emergency And Hospital Medicine Reports, 11(2), 35-48.
23. Panchal, AR, Berg, KM, Kudenchuk, PJ, Del Rios, M, Hirsch, KG, Link, MS, et al. (2018). 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 138(23), e740-e749.
24. Petitpas, F, Guenezan, J, Vendeuvre, T, Scepi, M, Oriot, D, Mimoz, O. (2016). Use of intra-osseous access in adults: A systematic review. Critical Care, 20(1), 102.
25. Pfeiffer, D, Olivieri, M, Brenner, S, Gomes, D, Lieftüchter, V, Hoffmann, F. (2023). Factors influencing the success and complications of intraosseous access in pediatric patients—A prospective nationwide surveillance study in Germany. Frontiers in Pediatrics, 11.
26. Philbeck, TE, Puga, TA, Montez, DF, Davlantes, C, DeNoia, EP, Miller, LJ. (2022). Intraosseous vascular access using the EZ-IO can be safely maintained in the adult proximal humerus and proximal tibia for up to 48 h: Report of a clinical study. The Journal of Vascular Access, 23(3), 339-347.
27. Philbeck, T, McDonald, J, Ross, C. (2023). 166 Real World Evidence Demonstrates Safety and Performance of Intraosseous Vascular Access, Including for Longer Duration of Use in Pediatric Patients. Annals of Emergency Medicine, 82(4, Supplement), S75.
28. Reades, R, Studnek, JR, Vandeventer, S, Garrett, J. (2011). Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: A randomized controlled trial. Annals of Emergency Medicine, 58(6), 509-516.
29. Righi, N, Paxton, JH. (2022). Flow Rate Considerations for Intraosseous Catheter Use. Current Emergency and Hospital Medicine Reports, 10(4), 125-133.
30. Rosenberg, H, Cheung, WJ. (2013). Intraosseous access. CMAJ : Canadian Medical Association Journal, 185(5), E238.
31. Sarkar, D, Philbeck, T. (2009). The Use of Multiple Intraosseous Catheters in Combat Casualty Resuscitation. Military Medicine, 174(2), 106-108.
32. Soar, J, Nolan, JP, Böttiger, BW, Perkins, GD, Lott, C, Carli, P, et al. (2015). European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation, 95, 100-147.
33. Strandberg, G, Eriksson, M, Gustafsson, MG, Lipcsey, M, Larsson, A. (2012). Analysis of intraosseous samples using point of care technology: An experimental study in the anaesthetised pig. Resuscitation, 83(11), 1381-1385.
34. Strandberg, G, Larsson, A, Lipcsey, M, Michalek, J, Eriksson, M. (2015). Intraosseous and intravenous administration of antibiotics yields comparable plasma concentrations during experimental septic shock. Acta Anaesthesiologica Scandinavica, 59(3), 346-353.
35. Sulava, E, Bianchi, W, McEvoy, CS, Roszko, PJ, Zarow, GJ, Gaspary, MJ, et al. (2021). Single Versus Double Anatomic Site Intraosseous Blood Transfusion in a Swine Model of Hemorrhagic Shock. Journal of Surgical Research, 267, 172-181.
36. Sunde, GA, Heradstveit, BE, Vikenes, BH, Heltne, JK. (2010). Emergency intraosseous access in a helicopter emergency medical service: A retrospective study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 18(1), 52.
37. Szydlowski, B, Nolte, J, Vershilovsky, E. (2021). Recent Advances in Intraosseous Vascular Access. Current Emergency and Hospital Medicine Reports, 9(3), 82-88.
38. Şimşek, P, Gürsoy, A, Bıyık Bayram, Ş. (2018). İlaç Uygulamaları İçin Farklı Bir Yol: İntraosseöz Ulaşım ve İnfüzyon. Journal of Education & Research in Nursing/Hemşirelikte Eğitim ve Araştırma Dergisi, 15(1).
39. Tocantins, LM, O’neill, JF, Jones, HW. (1941). Influsions Of Blood and Other Fluids Vıa The Bone Marrow: Application in Pediatrics. Journal of the American Medical Association, 117(15), 1229-1234.
40. Tyler, JA, Perkins, Z, De’Ath, HD. (2021). Intraosseous access in the resuscitation of trauma patients: A literature review. European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society, 47(1), 47-55.
41. Ummenhofer, W, Frei, FJ, Urwyler, A, Drewe, J. (1994). Are laboratory values in bone marrow aspirate predictable for venous blood in paediatric patients? Resuscitation, 27(2), 123-128.
42. Von Hoff, DD, Kuhn, JG, Burris, HA, Miller, LJ. (2008). Does intraosseous equal intravenous? A pharmacokinetic study. The American Journal of Emergency Medicine, 26(1), 31-38.
43. Wang, D, Deng, L, Zhang, R, Zhou, Y, Zeng, J, Jiang, H. (2023). Efficacy of intraosseous access for trauma resuscitation: A systematic review and meta-analysis. World Journal of Emergency Surgery: WJES, 18(1), 17.
44. Zunkovic, M, Markota, A, Lesnik, A. (2022). Attitudes towards the Utilization of Intraosseous Access in Prehospital and Emergency Medicine Nursing Personnel. Medicina-Lithuania, 58(8), 1086.