Intraosseous administration

If an i.v. line cannot be placed, the intraosseous drug administration route can be used for pediatric patients during, for example, cardiopulmonary resuscitation (CPR) because drug delivery by this route is similar to that for i.v. administration.If drug or fluid deliver by this route is sluggish, a saline flush can be used to clear the needle. Intraosseous administration is used to deliver medications such as epinephrine, atropine, sodium bicarbonate, dopamine, diazepam, isoproterenol, phenytoin, phenobarbital, dexametha-sone, and various antibiotics. ... 

Intraosseous administration is a feasible alternative to intravenous injection of some antimicrobial agents (sodium ampicillin or amoxicillin, cefotaxime, gentamicin or amikacin sulfate) in neonatal foals (less than 7 days of age). This particularly applies in the treatment of septicemia in neonatal foals that are in a state of septic shock or dehydration or both. The plasma concentration profiles for amikacin administered intraosseously and intravenously to neonatal foals are similar (Fig. 4). ... 

The variability associated with drug absorption from the gastrointestinal tract can be overcome by using a parenteral preparation (dosage form). It should preferably be administered either by intravenous infusion or slow intravenous injection to avoid circulatory overload. Intraosseous administration is a useful alternative to intravenous injection of some antimicrobial agents (e.g. sodium ampicillin or amoxycillin, cefotaxime, ceftriaxone, gentamicin or amikacin sulphate) in neonatal foals (Fig. 7.1) (Golenz et al, 1994) and puppies (Lavy et al, 1995). This particularly applies when the neonate is in a state of septic shock and/or dehydration. Total plasma protein concentration is an inaccurate index of hydration status unless monitored (repeatedly measured) and interpreted in conjunction with packed cell volume (PCV). 

Central venous catheter access results in faster and higher peak drug concentrations than peripheral venous administration, but central line access is not needed in most resuscitation attempts. However, if a central line is already present, it should be the access site of choice. If IV access (either central or peripheral) has not been established, a large peripheral venous catheter should be inserted. Intraosseous (IO) administration is the preferred alternative if IV administration cannot be achieved. 

The ability to carry out some routine medical interventions, such as intravenous access and advanced airway management, is usually attenuated by PPE. In this case, intraosseous access may be a more appropriate and dependable mode for the administration of drugs or fluids for resuscitation. The use of a laryngeal mask airway (LMA) may temporise an otherwise unprotected airway in an unconscious patient until that casualty can be extricated, decontaminated and moved safely into the cold zone. 

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