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Intraossäre Infusionstechnik

Technique of intraosseous infusion

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Zusammenfassung

Die intraossäre Infusionstechnik ist zum festen Bestandteil in der pädiatrischen aber auch adulten Notfallmedizin geworden und gehört heute zu den wichtigsten Fertigkeiten eines Notarztes, Pädiaters, Anästhesisten und Intensivmediziners. Die intraossäre Infusionstechnik ist eine sichere, zuverlässige und schnelle Methode, um bei Kindern unter 6 Jahren mit Kreislaufstillstand oder schwerem hypovolämischem Schock primär und beim vital gefährdeten Kind mit schwierigen Venenverhältnissen sekundär einen Gefäßzugang zu legen. Auf diesem Weg können alle in der Notfallmedizin intravenös verabreichten Medikamente und Flüssigkeiten nahezu uneingeschränkt, im Vergleich zur intravenösen Gabe in äquivalenter Dosierung und mit vergleichbaren Anschlagszeiten appliziert werden. Kenntnisse über Indikationen, Punktionsstellen, Material, Technik, Vorsichtsmaßnahmen und Komplikationen sowie Training am Übungsknochen sind wichtig für den sicheren und erfolgreichen klinischen Einsatz. Bei richtiger Indikationsstellung gibt es abgesehen von lokalen Gründen wie Frakturen, voroperierter Knochen oder kürzlich vorausgegangene Punktionsversuche sowie Durchblutungsstörungen der betroffenen Extremität keine absoluten Kontraindikationen für eine intraossäre Infusion. Komplikationen sind bei richtiger Anwendung und Handhabung extrem selten und das Risiko steht in keinem Verhältnis zu den Vorteilen einer intraossären Infusion beim vital bedrohten Patienten.

Abstract

Intraosseous infusion has become a cornerstone in pediatric and adult emergency medicine and belongs to one of the most important knowledge and skills of an emergency physician, pediatrician, anesthetist and intensivists. Intraosseous infusion is a safe, reliable and fast technique for primary vascular access in children <6 years of age with cardiac arrest or severe hypovolaemic shock and for secondary vascular access in the child in life-threatening conditions and difficult venous access. All drugs and fluids used in emergency medicine can be used by the intraosseous route almost without restriction and in similar dosage and efficiency as by the venous route. Besides local factors such as fracture, previous orthopedic or surgical procedures, recent intraosseous puncture as well as vascular disturbances of the extremity there are no general contraindications for intraosseous infusion if indication is chosen correctly. Incidence of complications is low if intraosseous infusion technique is correctly performed and the potential risks are negligible compared with the advantages for the life-threatened child. Knowledge about indications, sites of puncture, equipment, technique, precautions and complications as well as training with mannequin bones are mandatory for the safe and successful clinical use of this technique.

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  1. Anästhesieabteilung, Universitäts-Kinderkliniken Zürich, Steinwiesstrasse 75, 8032, Zürich, Schweiz

    M. Weiss, J. Gächter-Angehrn & D. Neuhaus

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  1. M. Weiss
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Weiss, M., Gächter-Angehrn, J. & Neuhaus, D. Intraossäre Infusionstechnik. Notfall Rettungsmed 10, 99–116 (2007). https://doi.org/10.1007/s10049-007-0900-0

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