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Invasive Techniken in der Notfallmedizin

III. Die intraossäre Punktion — Ein alternativer Gefäßzugang in pädiatrischen Notfallsituationen

Invasive techniques in emergency medicine

III. Intraosseous punction — An alternative vascular access in paediatric emergencies

  • Notfallmedizin
  • Published:
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Zusammenfassung

Die Indikation zur intraossären (IO-)Punktion umfasst alle Notfallsituationen bei pädiatrischen Patienten (≤6 Jahre), bei denen dringlich ein Gefäßzugang geschaffen werden muss, der konventionell nicht oder nur verzögert gelegt werden kann. Bei gleichzeitig schwierigen Venenverhältnissen, insbesondere bei Herz-Kreislauf-Stillstand und ausgeprägtem hämorrhagischen Schock, sollte der primäre IO-Gefäßzugang auch ohne vorausgegangene konventionelle Punktionsversuche bevorzugt werden. Kontraindiziert ist die (präklinische) Anlage bei einer Fraktur nahe der Punktionsstelle. Der klassische Zugang erfolgt über die proximale Tibia mit speziellen IO-Kanülen. Nahezu alle Medikamente und Infusionen, die bei der präklinischen Notfallbehandlung intravenös appliziert werden, können auch sicher über den IO-Zugang verabreicht werden; hyperton-hyperonkotische Lösungen gehen möglicherweise mit einem erhöhten Osteomyelitisrisiko einher. Dosierung, Anschlagzeit und Wirkdauer unterscheiden sich nicht zur intravenösen Gabe. Zur Vermeidung von Spätkomplikationen, z. B. einer Osteomyelitis, sind die frühzeitige innerklinische Entfernung der IO-Kanüle und der Wechsel auf einen peripher- bzw. zentralvenösen Gefäßzugang anzustreben.

Abstract

There can be few more daunting challenges for the emergency physician than an infant or small child in shock or cardiac arrest. At the best of times, the combination of small veins and abundant subcutaneous tissue makes vascular access difficult or impossible, even in experienced hands. For these situations, the intraosseous vascular access is an easy, rapid and safe alternative. The intraosseous route is recommended for children ≤6 years of age, where conventional vascular access cannot be timely established. The preferred sites are the medial aspect of the proximal end of the tibia, just below the tibial tuberosity. Access should be obtained with a commercially available intraosseous needle. All emergency drugs and infusion fluids for intravenous usage can safely be infused via the intraosseous route (except hypertonic solutions) and it is not necessary to adjust drug dosage compared to the intravenous route. To avoid complications caused by the intraosseous needle, such as osteomyelitis, it should be replaced within 2 h by a conventional vascular access.

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Authors and Affiliations

  1. Abteilung für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Ulm

    M. Helm, S. Fischer, J. Hauke & L. Lampl

  2. Klinik für Anästhesiologie, Universität Heidelberg, Heidelberg

    A. Gries

  3. Abteilung für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89070, Ulm

    M. Helm

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  1. M. Helm
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  2. A. Gries
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  3. S. Fischer
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  4. J. Hauke
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  5. L. Lampl
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Correspondence to M. Helm.

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Helm, M., Gries, A., Fischer, S. et al. Invasive Techniken in der Notfallmedizin. Anaesthesist 54, 49–56 (2005). https://doi.org/10.1007/s00101-004-0767-0

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