(BQ) Part 2 book “ABC of practical procedures” has contents: Emergency – Intraosseous access and venous cutdown, airway – basic airway manoeuvres and adjuncts, endotracheal intubation, ascitic drain, chest drain, central line, urinary catheterization, and other contents. | CHAPTER 12 Access: Emergency – Intraosseous Access and Venous Cutdown Matt Boylan Midlands Air Ambulance, DCAE Cosford, UK Poor technique . Infrequent user OVER VI EW By the end of this chapter you should be able to: • understand the indications for intraosseous access and venous cutdown • identify the sites used for intraosseous access and venous cutdown Venous shutdown . shock, cold Vein damage . IV drug abuse Difficult intravenous access Entrapment . limited access Extremes of age . elderly, infants • be aware of different types of intraosseous access devices • describe the procedure of performing intraosseous access and venous cutdown Limb injuries . amputations • understand the contraindications for intraosseous access and PPE . CBRN Environment . low light venous cutdown. Figure Difficult intravenous access. Compact bone Introduction Gaining access to the circulatory system in the critically ill or injured patient is an essential part of the resuscitative process. Failure to do so can result in significant delays in the delivery of life-saving treatment. There are situations where peripheral intravenous access may be difficult or even impossible (Figure ). Intraosseous access and venous cutdown are useful alternatives in this situation. Where possible a full explanation of the proceedure should be given to the patient and informed consent gained. However, in many cases this will not be possible. Osteon Trabeculae Periosteum Haversian or central canal Intraosseous access The intraosseous (IO) space consists of spongy cancellous epiphyseal bone and the diaphyseal medullary cavity. It houses a vast non-collapsible venous plexus that communicates with the arteries and veins of the systemic circulation via small channels in the surrounding compact cortical bone (Figure ). Drugs or fluids administered into the intraosseous space via a needle or catheter will pass rapidly into the systemic circulation at a .
