Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword (1)
- Foreword (2)
- Preface
- Acknowledgments
- Section 1 Organization of neonatal transport
- Section 2 Basics in cardiopulmonary resuscitation of newborn infants
- Basic equipment setup for initial neonatal care and resuscitation
- Drugs for neonatal emergencies
- Postnatal cardiopulmonary adaptation
- ABC Techniques and Procedures
- Sunctioning
- Stimulation, oxygen supplementation, bag-and-mask ventilation (M-PPV), pharyngeal/bi-nasal CPAP, and pharyngeal positive pressure ventilation
- Endotracheal intubation and gastric tube placement
- Laryngeal mask airway (LMA)
- Chest compressions
- Peripheral venous access
- Umbilical vein/artery catheterization (UVC, UAC)
- Central venous access (internal jugular vein)
- Intraosseous access
- Cord clamping
- Management of high-risk infants in the delivery room
- Monitoring in the delivery room and during neonatal transport
- Hygiene in the delivery room and during neonatal transport (infection control)
- When to call a pediatrician to the delivery room
- Checklist for the postnatal treatment of newborn infants
- Assigning individual duties in the delivery room
- Clinical assessment of the newborn infant
- Cardiopulmonary resuscitation of newborn infants at birth
- Volume therapy and sodium bicarbonate supplementation in preterm and term newborn infants
- Absolute and relative indications for neonatal transport and NICU admission
- Communication with mother and father
- Coordinating neonatal transport and patient sign-out to the NICU team
- Documentation and feedback after neonatal emergency transport
- Ethics in neonatal intensive care
- Perinatal images of preterm and term infants
- Mechanical ventilation of the neonate
- Questions for review (basics)
- References (Section 2)
- Section 3 Classic and rare scenarios in the neonatal period
- Section 4 Transport
- Section 5 Appendix
- Index
- Plate section
Intraosseous access
from Section 2 - Basics in cardiopulmonary resuscitation of newborn infants
Published online by Cambridge University Press: 05 March 2012
- Frontmatter
- Contents
- List of contributors
- Foreword (1)
- Foreword (2)
- Preface
- Acknowledgments
- Section 1 Organization of neonatal transport
- Section 2 Basics in cardiopulmonary resuscitation of newborn infants
- Basic equipment setup for initial neonatal care and resuscitation
- Drugs for neonatal emergencies
- Postnatal cardiopulmonary adaptation
- ABC Techniques and Procedures
- Sunctioning
- Stimulation, oxygen supplementation, bag-and-mask ventilation (M-PPV), pharyngeal/bi-nasal CPAP, and pharyngeal positive pressure ventilation
- Endotracheal intubation and gastric tube placement
- Laryngeal mask airway (LMA)
- Chest compressions
- Peripheral venous access
- Umbilical vein/artery catheterization (UVC, UAC)
- Central venous access (internal jugular vein)
- Intraosseous access
- Cord clamping
- Management of high-risk infants in the delivery room
- Monitoring in the delivery room and during neonatal transport
- Hygiene in the delivery room and during neonatal transport (infection control)
- When to call a pediatrician to the delivery room
- Checklist for the postnatal treatment of newborn infants
- Assigning individual duties in the delivery room
- Clinical assessment of the newborn infant
- Cardiopulmonary resuscitation of newborn infants at birth
- Volume therapy and sodium bicarbonate supplementation in preterm and term newborn infants
- Absolute and relative indications for neonatal transport and NICU admission
- Communication with mother and father
- Coordinating neonatal transport and patient sign-out to the NICU team
- Documentation and feedback after neonatal emergency transport
- Ethics in neonatal intensive care
- Perinatal images of preterm and term infants
- Mechanical ventilation of the neonate
- Questions for review (basics)
- References (Section 2)
- Section 3 Classic and rare scenarios in the neonatal period
- Section 4 Transport
- Section 5 Appendix
- Index
- Plate section
Summary
Indication
In emergency situations, when administering drugs, fluids, blood, and blood products, intraosseous (IO) access is indicated when attempts at obtaining peripheral or central venous access (e.g., UVC, femoral vein catheter) have failed (Figure 2.34). Intraosseous access has been successfully used during pediatric critical care transport, in intensive care units, and in emergency departments. A recent retrospective study of pediatric critical care transport showed that IO access was performed in 2.6% of 1792 children with a first-attempt success rate of 78%. However, in this study, only 23 patients were <1 year old. The first-attempt success rate in these infants was lower (74%), indicating not only a need for further training but also an unjustified hesitation to place IO needles in infants and neonates.
• IO access can be established in all age groups (i.e., from newborns to adults).
• IO access can often be achieved in 30–60 seconds.
• The IO route of administration is preferred to the ET route.
• Any drug or fluid that is administered IV can be given IO (PALS Manual, 2006).
Equipment
Intraosseous (IO) needle (18 G, e.g., Cook™ “Standard Tip Design” or “Dieckmann modification model” with two sideholes at the tip of the IO needle). IO needles work by a careful-push-no-thread technique. You may use 16 G IO needles in newborns >3.5 kg body weight and older infants (no data). As an alternative to IO needles, you may use a disposable iliac bone marrow aspiration needle (18 G). Use 18 G IO needles in preterm babies.
Skin disinfectant (e.g., povidone-iodine)
Sterile drape with hole or sterile towels
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- Neonatal Emergencies , pp. 117 - 120Publisher: Cambridge University PressPrint publication year: 2009