Skip to main content
SpringerLink
Log in

C-Intraossäre Punktion

Eine Übersicht der aktuell verfügbaren Systeme

C-Intraosseous access

A review of currently available systems

  • Leitthema
  • Published:
Notfall + Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Bei der notfallmedizinischen Versorgung von kritisch kranken bzw. schwerverletzten Patienten ist die zeitgerechte Etablierung eines Zugangs zum Gefäßsystem zur Durchführung einer spezifischen Pharmako- und Infusionstherapie oftmals von zentraler Bedeutung. Allerdings kann dies in Notfallsituationen mit großen Schwierigkeiten verbunden sein, insbesondere unter dem gegebenen Zeitdruck. Hier kann die intraossäre (IO) Punktion als rasches, effektives und sicheres Verfahren zur Applikation von Medikamenten, Infusionslösungen und Blutprodukten in Notfallsituationen die Lösung des Problems sein. Dabei kommt eine Vielzahl an Medizinprodukten zur Anwendung, mit denen sich der Notfallmediziner hinsichtlich der Anwendung und auch der Technik auseinandersetzen muss.

Ziel

Im vorliegenden Artikel werden die aktuell auf dem Markt verfügbaren IO-Punktionssysteme vorgestellt, eingeteilt und systematisch einander gegenübergestellt.

Material und Methoden

Recherche und Auswertung aktueller Literatur.

Ergebnisse und Schlussfolgerungen

Die Autoren verglichen die Systeme anhand festgelegter Parameter wie u. a. Alters- und Gewichtsgruppen, Erfolgsraten, Anlagedauer, Flow und Handling. Zudem wurden Zeichen der korrekten Platzierung sowie spezifische systemabhängige Komplikationen dargestellt. Sämtliche aktuell auf dem Markt befindliche IO-Systeme erfüllen die Anforderungen an ein ideales IO-System nur mehr oder weniger bedingt – Das (ideale) IO-System gibt es (noch) nicht. So bleibt es dem Anwender überlassen, für welches System er sich nun entscheidet. Durch die Möglichkeit des Einsatzes bei praktisch sämtlichen Gewichts- bzw. Altersgruppen, hohen (primären) Erfolgsraten, bei gleichzeitig einfacher und sicherer Anwendung und geringen Komplikationsraten scheint das semiautomatische EZ-IO-System unter dem Aspekt der Universalität besonders geeignet.

Abstract

Background

Establishing vascular access is often a critical component in the treatment of critically ill or severely injured patients to perform a specific pharmacotherapy and infusion therapy. Intraosseous access can be quickly obtained in situations where intravenous access is difficult to achieve. It is an effective and safe method for the administration of drugs, infusions and blood products in the emergency setting.

Objective

In this article the currently available intraosseous vascular access devices are presented, classified and compared.

Material and methods

A systematic review was conducted using MEDLINE (via PubMed) and the Cochrane library database. The primary aim was to present the scope of currently available intraosseous devices. The secondary aim was to compare these intraosseous devices regarding their specifications.

Results and conclusion

We compared the intraosseous devices based on specific parameters, such as age and weight groups, first attempt and overall success rates, insertion time, flow rates and handling. In addition, signs of correct needle placement and specific system-related complications are outlined. All currently available intraosseous devices generally meet the requirements for an ideal system more or less. An (ideal) intraosseous puncture system does not currently exist. It is up to the provider to select an intraosseous puncture system, which best meets the particular requirements. In summary, due to the possibility of the use for virtually all weight and age groups, a high (primary) success rate as well as simple and safe application and low complication rates, the semiautomatic EZ-IO system seems particularly suitable in terms of universal application.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Ahrens KL, Reeder SB, Keevil JG et al (2013) Successful computed tomography angiogram through tibial intraosseous access: a case report. J Emerg Med 45:182–185

    Article  PubMed  Google Scholar 

  2. Anson JA (2014) Vascular access in resuscitation. Is there a role for the intraosseous route? Anesthesiology 120(4):1013–1031

    Article  Google Scholar 

  3. Bernhard M, Gräsner J, Gries A et al (2010) Die intraossäre Infusion in der Notfallmedizin – Empfehlungen des Wissenschaftlichen Arbeitskreises Notfallmedizin und des Wissenschaftlichen Arbeitskreises Kinderanästhesie der DGAI. Anästh Intensivmed 51:615–620

    Google Scholar 

  4. Brenner T, Bernhard M, Helm M et al (2008) Comparison of two intraosseous infusion systems for adult emergency medical use. Resuscitation 78:314–319

    Article  PubMed  Google Scholar 

  5. Byarsa DV, Tsuchitania SN, Erwina E et al (2011) Evaluation of success rate and access time for an adult sternal intraosseous device deployed in the prehospital setting. Prehosp Disaster Med 26(02):127–129

    Article  Google Scholar 

  6. Calkins MD, Fitzgerald G, Bentley TB et al (2000) Intraosseous infusion devices: a comparison for potential use in special operations. J Trauma 48(6):1068–1074

    Article  CAS  PubMed  Google Scholar 

  7. Chatterjee DJ, Bukunola TL, Samuels TL et al (2011) Resuscitation in massive obstetric haemorrhage using an intraosseous needle. Anaesthesie 66:306–310

    Article  CAS  Google Scholar 

  8. Cheung W, Rosenberg H, Vaillancourt C (2014) Barriers and facilitators to intraosseous access in adult resuscitations when peripheral intravenous access is not achievable. Acad Emerg Med 21:250–256

    Article  Google Scholar 

  9. Demir O et al (2014) Comparison of two intraosseous devices in adult patients in the emergency setting: a pilot study. Eur J Emerg Med. doi:10.1097/mej.0000000000000187

    Google Scholar 

  10. Dev SP, Stefan RA, Saun T et al (2014) Insertion of an intraosseous needle in adults. N Engl J Med 370:e35

    Article  PubMed  Google Scholar 

  11. Eich C, Weiss M, Neuhaus D et al (2010) Die intraossäre Punktion in der Kindernotfallmedizin und Kinderanästhesie. Anästh Intensivmed 51:75–81

    Google Scholar 

  12. Findlay J, Johnson DL, Macnab AJ et al (2006) Paramedic evaluation of an adult intraosseous infusion system. Prehosp Disaster Med 21(5):329–335

    Article  PubMed  Google Scholar 

  13. Gerritse BM, Scheffer GJ, Draisma JM (2009) Prehospital intraosseous access with the bone injection gun by a helicopter-transported emergency medical team. J Trauma 66:1739–1741

    Article  PubMed  Google Scholar 

  14. Hallas P, Brabrand M, Folkestad L (2013) Complication with intraosseous access: Scandinavian users’ experience. West J Emerg Med XIV(5):440–443

    Article  Google Scholar 

  15. Halm B, Yamamoto LG (1998) Comparing ease of intraosseous needle placement: Jamshidi versus cook. Am J Emerg Med 16(4):420–421

    Article  CAS  PubMed  Google Scholar 

  16. Hartholz KA et al (2010) Intraosseous devices – a rendomized controlled trial comparing three intraosseius devices. Prehosp Emerg Care. doi:10.3109/10903120903349861

    Google Scholar 

  17. Helm M, Breschinski W, Lampl L et al (1996) Die intraossäre Punktion in der präklinischen Notfallmedizin. Anaesthesist 45:1196–1202

    Article  CAS  PubMed  Google Scholar 

  18. Helm M, Hauke J, Bippus N, Lampl L (2007) Die intraossäre Punktion in der präklinischen Notfallmedizin. Anaesthesist 56:18–24

    Article  CAS  PubMed  Google Scholar 

  19. Helm M, Fischer S, Hauke J et al (2008) Invasive Techniken in der Notfallmedizin – Der intraossäre Zugang. Notf Rettungsmed 11:317–324

    Article  Google Scholar 

  20. Helm M, Hossfeld B, Schlechtriemen T et al (2011) Einsatz der intraossären Infusion im deutschen Luftrettungsdienst – Bundesweite Analyse im Zeitraum von 2005–2009. Anaesthesist 60:1119–1125

    Article  CAS  PubMed  Google Scholar 

  21. Helm M, Haunstein B, Schlechtriemen T et al (2015) EZ-IO intraosseous device implementation in German HEMS. Resuscitation 88:43–47

    Article  PubMed  Google Scholar 

  22. Helm M, Schlechtriemen T, Haunstein B et al (2013) Intraossäe Punktion im Deutschen Luftrettungsdienst – Leitlinienempfehlungen vs. Einsatzrealität. Anaesthesist 62:981–987

    Article  CAS  PubMed  Google Scholar 

  23. Haruyama AZ, Chang KS, Yamamoto LG (2000) Comparison of a new screw-tipped intraosseous needle versus a standard bone marrow aspiration needle for infusion. Am J Emerg Med 18:135–139

    Article  PubMed  Google Scholar 

  24. Johnson DL, Findlay J, Stair TO et al. Device for Fast Field Intraosseus Infusion via the Adult Manubrium. University of Maryland at Baltimore; Pyng Medical Corp, Harvard Medical School, Brigham and Women’s Hospital Baltimore

  25. Kalechstein S (2012) Evaluation of a new pediatric intraosseous needle insertion device for low ressource settings. J Pediatr Surg 47:974–979

    Article  PubMed  Google Scholar 

  26. Kurowski A, Timler D, Evrin T et al (2014) Comparison of 3 different intraosseous access devices for adult during resuscitation. Randomized crossover manikin study. Am J Emerg Med 32(12):1490–1493

    Article  PubMed  Google Scholar 

  27. LaRocco BG, Wang HE (2003) Intraosseous infusion. Prehosp Emerg Care 7(2):280–285

    Article  PubMed  Google Scholar 

  28. LaSpada J, Kissoon N (1995) Extravasation rates and complications of intraosseous needles during gravity and pressure infusion. Crit Care Med 23:2023–2028

    Article  CAS  PubMed  Google Scholar 

  29. Lee PMJ, Lee C, Rattner P et al (2015) Intraosseous versus central venous catheter utilization and performance during inpatient medical emergencies. Crit Care Med 43:1233–1238

    Article  PubMed  Google Scholar 

  30. Leidel BA, Kirchhoff C, Bogner V et al (2009) Is the intraosseous route fast and efficacious compared to conventional central venous catherization in adult patients under resuscitation in the emergency department? A prospective observational pilot study. Patient Saf Surg 3:24

    Article  PubMed  PubMed Central  Google Scholar 

  31. Leidel BA, Kirchhoff C, Braunstein V et al (2010) Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: a prospective study and review of the literature. Resuscitation 82:126–129

    Google Scholar 

  32. Levitan RM et al (2009) Use of a battery-operated needle driver for intraosseous access by novice users: skill acquisition with cadavers. Ann Emerg Med 54:692–694

    Article  PubMed  Google Scholar 

  33. Lewis P, Wright C (2015) Saving the critically injured trauma patient: a retrospective analysis of 1000 uses of intraosseous access. Emerg Med J 32:463–467

    Article  PubMed  Google Scholar 

  34. Lingner M, Niederer O, Majolk J et al (2014) Die intraossäre Infusion als Alternative in der Sepsistherapie beim Erwachsenen. Anasthesiol Intensivmed Notfallmed Schmerzther 49:100–103

    Article  PubMed  Google Scholar 

  35. Macnab A, Christenson J, Findlay J et al (2000) A new system for sternal intraosseous infusion in adults. Prehosp Emerg Care 4:173–177

    Article  CAS  PubMed  Google Scholar 

  36. Maconochie IA, Bingham R, Eich C et al (2015) European resuscitation council guidelines for resuscitation. Section 6. Pediatric life support. Resuscitation 98:223–248

    Article  Google Scholar 

  37. Miller DD, Guimond G, Hostler DP, Platt T, Wang HE (2005) Feasibility of sternal intraosseous access by emergency medical technician students. Prehosp Emerg Care 9:73–78

    Article  PubMed  Google Scholar 

  38. Miller L (2010) A two phase study of fluid administration measurement during intraosseous infusion. Ann Emerg Med 56:S151

    Article  Google Scholar 

  39. Miner WF, Corneli HM, Bolte RG et al (1989) Prehospital use of intraosseous infusion by paramedics. Pediatr Emerg Care 5:5–7

    Article  CAS  PubMed  Google Scholar 

  40. NIO Adult White Paper. French Army Evaluation of the “NIO Adult” Intraosseous infusion device. The PerSys Medical Group

  41. NIO Adult – Summary of Clinical study of human cadavers. Device Performance and Validation Tests. New York Institute of Technology College of Osteopathic Medicine

  42. Ohchi O, Komasawa N, Mihara R et al (2015) Comparison of mechanical and manual bone marrow puncture needle for intraosseous access; a randomized simulation trial. SpringerPlus 4:211

    Article  PubMed  PubMed Central  Google Scholar 

  43. Olsen D, Packer BE, Perrett J et al (2002) Evaluation of the bone injection gun as a method for intraosseous cannula placement for fluid therapy in adult dogs. Vet Surg 31:533–540

    Article  PubMed  Google Scholar 

  44. Omg ME (2010) An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO. Am J Emerg Med 27:8–15

    Article  Google Scholar 

  45. Penketh J, McDonald M, Kelly FE (2016) EZ-IO(®) intraosseous access teaching in the workplace using a mobile ‘tea trolley‘ training method. Resuscitation 99:e17–e18

    Article  CAS  PubMed  Google Scholar 

  46. Philbeck TE, Puga T, Montez DF et al (2015) Sternal flow rates and insertion success using a multisite intraosseous device. Ann Emerg Med 66(4S):S48 (Research sponsored by Teleflex)

    Article  Google Scholar 

  47. http://ps-med.com/products/vascular/BIG-A. Zugegriffen: 11. August 2016

  48. Reinhardt L, Brenner Th, Bernhard M et al (2013) Four years of EZIO System in the pre- and inhospital setting. Cent Eur J Med 8(2):166–171

    Google Scholar 

  49. Rimer S, Westry JA, Rodriguez RL (1988) Compartment syndrome in an infant following emergency intraosseous infusion. Clin Pediatr (Phila) 27:259–260

    Article  Google Scholar 

  50. Rush S, D’Amore J, Boccio E (2014) A review of the evolution of intraosseous access in tactical settings and a feasibility study of a human cadaver model for a humeral head approach. Mil Med 179(8S):24

    Article  PubMed  Google Scholar 

  51. Schalk R, Schweigkofler U, Lotz G et al (2011) Efficacy of the EZ-IO needle driver for out-of-hospital intraosseous access – A preliminary, observational, multi-center study. Scand J Trauma Resusc Emerg Med 19:65

    Article  PubMed  PubMed Central  Google Scholar 

  52. Schwartz D, Amir L, Dichter R et al (2008) The use of a powered device for intraosseous drug and fluid administration in an national EMS: a 4‑year experience. J Trauma 64:650–654

    Article  CAS  PubMed  Google Scholar 

  53. Springs NM et al (2007) Comparison oft wo intraosseous infusion techniques in an EMT training program (abstract). Acad Emerg Med 7:1168

    Google Scholar 

  54. Sogar J, Nolan JP, Deakin JP et al (2015) European resuscitation council guidelines for resuscitation. Section 3. Adult advanced life support. Resuscitation 98:100–147

    Google Scholar 

  55. Stevens K, Purssell R, Macnab AJ et al (2001) Paramedic evaluation of the Pyng F.A.S.T. 1 Intraosseous Infusion System. J Investig Med 49(1):34A

    Google Scholar 

  56. Sunde GA, Heradstveit BE, Vikenes BH et al (2010) Emergency intraosseous access in a helicopter emergency medical service: a retrospective study. Scand J Trauma Resusc Emerg Med 18:52

    Article  PubMed  PubMed Central  Google Scholar 

  57. The T.A.L.O.N.™ 7‑SITE INTRAOSSEOUS VASCULAR ACCESS SYSTEM, Vidacare® Clinical & Science Department

  58. Horwood BT, Adams J, Tiffany BR, Pollack CV et al (1999) Prehospital use of a sternal intraosseous infusion device. Ann Emerg Med 34(4):S65–S66

    Article  Google Scholar 

  59. Tobias J, Ross A (2010) Intraosseous infusions: a review for the anaesthesiologist with a focus on pediatric use. Anesth Analg 110(2):391–401

    Article  PubMed  Google Scholar 

  60. Wagner MB, McCabe JB (2012) A comparison of four techniques to establish intraosseous infusion. J Ped Surg 47:87–91

    Article  Google Scholar 

  61. Wilson MH, Habik K, Wright Ch et al (2015) Pre-hospital emergency medicine. Lancet 386:2526–2534

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie & Intensivmedizin – Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89070, Ulm, Deutschland

    M. Helm OTA, A. Weißleder, B. Hossfeld, L. Lampl & M. Kulla

  2. Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Bernhard

Authors
  1. M. Helm OTA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Weißleder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Bernhard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Hossfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. Lampl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Kulla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Helm OTA.

Ethics declarations

Interessenkonflikt

M. Helm, A. Weißleder, M. Bernhard, B. Hossfeld, L. Lampl und M. Kulla geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Bernhard, Leipzig

B. Hossfeld, Ulm

C. Waydhas, Bochum

M. Helm und A. Weißleder haben zu gleichen Teilen zu dieser Publikation beigetragen.

Der Beitrag ist Teil des Leitthemas „Medizinprodukte“ der Ausgabe 2/17 der Notfall+Rettungsmedizin. In der Beitragsserie werden Medizinprodukte entsprechend dem ABCDE-Schema vorgestellt.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Helm, M., Weißleder, A., Bernhard, M. et al. C-Intraossäre Punktion. Notfall Rettungsmed 20, 117–126 (2017). https://doi.org/10.1007/s10049-017-0269-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-017-0269-7

Schlüsselwörter

Keywords

Search

Navigation