S4C32 - Neonatal and Pediatric Intraosseous and Central Venous Access

Question 1

What are some contraindications to IO

Answer 1

• overlying infection
• exposed bone
• underlying fracture
• structural bone d/o (OI)

Question 2

IO meds

Answer 2

• can give paralytics, anticonvulsants, analgesics, benzos, vasopressors, blood products
• anything IV can be given IO
• for RSI the onset of the meds may take a little longer than with IV`

Question 3

EZ-IO

Answer 3

• pink for peds (15mm)
• blue for adult (25mm)
• yellow for large adults (45mm)
• to be used in proximal tibia, distal tibia or proximal humerus
• IO can also be used in the sternum, ileum and clavicle

Question 4

IO insertion

Answer 4

• tibia: insert needle 2cm inferior to the tibial tuberosity (avoid physeal plate in children)
• enter distal tibia just superior to the medial malleolus (avoid saphenous vein which is 2cm anterior and 2 cm superior to the malleolus)
• femur - 2 finger breadths superior to the distal end of the femur
• insert needle, attach 5cc syringe and aspirate, then flush with 10cc NS, can give0.5mg/kg of 2% lido first then follow by flush to help with pain

Question 5

IO complications

Answer 5

• pain
• low risk of infxn
• extravastation can cause compartment syndrome
• growth plate injuries
• rarely fat emboli

Question 6

Indications for Central line in peds

Answer 6

• inability to obtain peripheral access
• need for invasive hemodynamic monitoring
• administration of caustic or hypertonic solutions
• need for long-term vascular access
• need for transvenous pacemaker

Question 7

IJ

Answer 7

• IJ lies lateral and posterior to the artery
• rotating the head 30-45 deg away from the given side helps to position the vein more lateral to the artery, do not rotate past 45deg as this brings the vein infront of the artery
• position head 45 deg from midline contralateral to the vessel being cannulated
• to increase IJ distension: valsalva, liver compression, trendelemburg
• right side has lower dome of lung, less chance of pneumo

Question 8

Femoral vein

Answer 8

• NAVEL

- nerve, artery, vein, empty space, lymphatics (nerve is most lateral)

Question 9

Umbilical Vein Catheter

Answer 9

• can be done in the first week of life
• 5.0F for term, 3.5F for preterm, inserted 4 cm
• place purse-string suture around stump so that it can be tightened in the event of bleeding
• cut the cord stump 2cm from abdo wall, no shorter
• vein is usually at the 12 o’clock position
• insert tip of catheter into the vein and aim towards the right shoulder
• check every cm for blood return by opening the stopcock and drawing gently on the syringe
• advance the catheter 1-2cm beyond good blood return, then tighten the purse-string suture

-complications: thrombosis, embolism, perforation, infxn, tissue ischemia, hepatic necrosis, hydrothorax, pericardial effusion, erosion of atrial/ventricular walls