B I G骨髓注射枪
美国生物医学公司的骨髓穿刺针产品说明书
SimpleOnly three componentsEfficientAll-in-one procedure tocapture the biopsy specimenBetterExcellent specimen withno tissue distortionOrdering informationCat. No.Description Qty. BMNI15GX2I-Type 15G x 2 in. bone marrow biopsy needle10/cs BMNI15GX4I-Type 15G x 4 in. bone marrow biopsy needle10/cs BMNJ11X4J-Type 11G x 4 in. bone marrow biopsy needle10/cs BMNJ11X6J-Type 11G x 6 in. bone marrow biopsy needle10/cs BMNJ8X5J-Type 8G x 5 in. bone marrow biopsy needle10/cs BMNJ13X2J-Type 13G x 2.5 in. bone marrow biopsy needle10/cs 31-CR1SF Safety bone marrow biopsy tray with J-Type needle, 11G x 4 in.10/cs 31-CR1SFDF Safety bone marrow biopsy tray with J-Type needle, 11G x 4 in. without lidocaine10/cs 31-CR2SF Safety bone marrow biopsy tray with J-Type and I-Type needles10/cs 31-CR2SFDF Safety bone marrow biopsy tray with J-Type and I-Type needles without lidocaine10/csTrocar point stylet• Long and sharp trocar point stylet effectively penetrates soft tissue and cortical bone, allowing precise access to the cancellous bone. It is also used for pushing the sample out of the needle at the end of the procedure.Cardinal Health™ Core Retention Bone Marrow Biopsy NeedleFeaturesInsertion aid• Insertion aid helps guide the introduction of the pusher rod into the mouth of theneedle and facilitates the delivery of the biopsy specimen through the opposite/proximal end of the needle.Outer serrations• A series of outer serrations supports drilling and helps the passage of the needle through the cortical layer of bone.• The cutting edge, designed for precision, helps ensure that the bony trabeculae is cut cleanly, giving a better biopsy sample.Unique core retaining device• The unique design allows the sample to expand within the needle, ensuring entrapment and safe capture of a better biopsy sample.No tissue distortion• The core retention bone marrow needle retrieves long, uniform core of marrow tissue with little or no distortion of marrow architecture.© 2021 Cardinal Health. All Rights Reserved. CARDINAL HEALTH, the Cardinal Health LOGO, ESSENTIALTO CARE are trademarks of Cardinal Health and may be registered in the US and/or in other countries. All other marks are the property of their respective owners. Lit. No. 2GM21-1383835-01 (04/2021)For more information, visit /CoreRetentionBoneMarrowNeedle。
骨髓输液的应用概述
套， 铺孔 巾。②局部麻醉 ： 用 注射 器抽吸 ２ ％利多 卡因从穿刺 点
用于抢救患者 ， 使骨髓输液技术不被重视 ， 逐渐退 出临床。１ ９ ７ ０ 年后 ， 由于在急救中发现 ， 有 些儿童患者 、 心脏停搏 的成年人等 ，
进针使麻 醉药 浸润到皮 肤 、 皮下、 骨膜。③根据 年龄 、 体型选 用
ｔ ｉ ｓ ＿ ５ 医生将骨 内输液首次 用于 临床 ， 主要用 于儿童 及新 生儿 的 急救 。尤其是第 ２次世界大 战期 间该技术 得到了蓬勃发展 。在
１ ９ ５ ０年后 ， 由于 医用 材料 的进 步 ， 静 脉插 管技 术 的发 明及 广泛
４ ． ３ 骨髓输液穿 刺方 法
① 常规 消毒穿 刺处 皮肤 ， 戴 无菌 手
手持 针以骨髓 穿刺针与骨干 垂直方 向旋转穿 刺 ， 当针尖接 触骨 质后旋转 针柄 缓慢钻入骨质 ， 当感到有 “ 落空感 ” 且穿刺针 已 固
定在 骨内直立不倒 时为止 。④拔 出针芯 ， 接上 ５ ｍ ｌ 或பைடு நூலகம் ０ ｍｌ 注射
较完善的研究 ， 依 靠骨髓 输液 技术 挽救 了大批濒 临死亡 的儿童
当代护士 ２ ０ １ ４年 ３月 中旬 刊
※综 述
骨 髓输 液 的应 用 概述
林巧 清
摘要 综述 了骨髓输液 的机理 、 发展 史、 适应症与禁忌症、 操作 流程 、 护理 方法、 持 续 时间、 并发 症的防 范及 处理措施 、 国内外临床应
用， 认为 骨髓输 液解剖 位置 固定、 标 志明确、 操作 简便 、 迅速安全、 穿刺成 功率 高， 可在 非 医疗机 构和基层 医疗站 中广泛应用。
关键 词 ： 骨髓 输液 ； 护理
中图分类号 ： Ｒ ４ ７ 文献标识码 ： Ａ 文章编号 ： １ ０ ０ ６ — ６ ４ １ １ （ ２ ０ １ ４ ） ０ ３ — ０ ０ ０ １ — ０ ２
骨髓腔输液(IO技术)在野战救护训练中的应用体会
临床医药文献电子杂志Electronic Journal of Clinical Medical Literature2019年第6卷第31期2019Vol.6No.3185参考文献[1] 张晓丽.硼替佐米治疗滤泡性淋巴瘤的不良反应和护理策略分析[J].心理医生,2016,22(1):173-174.[2]朱佳艳.硼替佐米治疗滤泡性淋巴瘤的临床护理体会[J].健康之路,2016(5):160-161.[3]杜晓凤,庄 莉,张 曼,等.硼替佐米联合地塞米松治疗原发性系统性淀粉样变性的不良反应观察和护理对策[J].东南国防医药,2017,19(5):527-529.本文编辑：刘欣悦骨髓腔输液（IO 技术）在野战救护训练中的应用体会王康康，吕 东，于善开，董 燕（解放军第960医院南院，山东 济南 250031）【摘要】现代战争三大致死原因：大出血、张力性气胸、气道梗阻；所以，快速的止血以及迅速地扩充血容量是抢救伤员生命的关键。
而骨髓腔输液技术（IO 技术）在野战救护训练中能够快速、有效的建立输液通道，迅速扩充血容量，为争取黄金一小时的救治时间奠定了基础。
【关键词】骨髓腔输液；野战救护；训练【中图分类号】R473 【文献标识码】A 【文章编号】ISSN.2095-8242.2019.31.85.02现代战争由于高科技武器的大量应用，使作战半径向大纵深、全方位扩展，武器杀伤力更加精确、快速、强大，短时间内战场上会造成大范围、大批量伤员，救治任务十分紧迫、繁重，伤员的救护难度更大。
自红军时代创立的“战救五项技术”，已无法满足现代高科技战争卫勤保障的需要。
新的战伤救治理念强调战场救治链前移，突出“白金10分钟”的重要救治作用。
因此，野战条件下，快速建立静脉通路，恢复有效循环血容量是挽救创伤性失血性休克伤员生命的关键环节，使用骨髓腔输液技术能够在紧急情况下快速建立输液通路，为抢救伤员赢得宝贵时间。
1 IO 技术的适用范围骨髓腔输液（IO 技术）是利用骨髓腔中丰富的血管网，将液体和药物经骨髓腔输入血液循环的一种给药途径。
骨髓腔穿刺工具的研究进展
肱骨或胸骨、锁骨、髂前上棘等，小儿 主要在胫骨近端或远端进行穿刺，在穿 刺针进入骨髓内以后，如果可以抽吸出 骨髓，证明穿刺成功。当选择的部位如 果有骨折时不能进行穿刺，这也是骨髓 腔穿刺的常见禁忌证[11]。
小结 IO 方法在国外很早已经普遍开展[12]，
Jamagdi 直针式输液器等，这种类型输液 器的优点在于安全、便捷、物美价廉 等，它的穿刺成功率儿童高于成人。直 针式的输液器缺点在于，穿刺过程中会出 现针头弯曲或断裂，穿刺部位也有可能会 发生液体渗漏。何春梅等对科室建立外周 静脉通道困难的患者改为胫骨 IO[5]，在此 次试验中，采用了 20 mL 注射器针头进 行穿刺，此方法也可行，只是也同样有 着上述缺点。
骨髓腔穿刺工具的发展 骨髓腔穿刺作为一种先进的、可靠
的技术，它的穿刺工具也不仅仅是单纯 的普通针。在临床上最早使用的装置为 手动装置，后逐渐发展为半自动装置、 注射枪等，随着临床的发展以及工作的
10 中国社区医师2019年第35卷第27期
需要，电动驱动装置成为目前临床中最 先进的穿刺装置。
不同穿刺工具介绍 手 动 穿 刺 装 置 ： 如 Diechmann、
BIG 骨内注射枪：这是一种易于操 作、快速骨内补液给药的途径，它是一 种冲击性驱动装置。BIG 注射枪最大特 点在于它能够在很短的时间内插入骨髓 腔，可以快速进行输注，确保了液体和 药物的使用[8]。
EZ-IO 驱动装置：它是一种密封电
钻式工具，是目前先进的电动驱动装 置，优点在于驱动性以及设计的特殊 性，使得穿刺的时候更加便捷，且成功 率普遍较高[9]。EZ-IO 装置的外观十分美 观，手枪式的握把贴合操作者手掌，让 整个操作过程不容易出现差错。陈贵洪 等研究结果表明 ， [10] 骨内输液组一次性 穿刺成功率、穿刺时长、抢救成功率均 优于中心静脉置管组。
骨髓内输液装置参数
骨髓内输液装置参数骨髓内输液装置是现代医学领域的一项重要技术，在医疗实践中发挥着关键作用。
它是通过将药物或液体输送到患者的骨髓内，以实现有效治疗和满足特殊医疗需求。
下面将介绍骨髓内输液装置的参数，以及其在临床应用中的指导意义。
首先，骨髓内输液装置的参数包括穿刺针头的长度和粗细，注射器的容量和流速，以及输液管的材质和弹性等。
这些参数需要根据患者的具体情况进行选择。
例如，对于儿童患者，应选择较短和较细的穿刺针头，以减少对骨髓的损伤。
对于需要大量输液的患者，应选择容量较大的注射器，以提高输液效率。
同时，输液管的材质和弹性也应符合医疗标准，以确保安全和舒适性。
其次，骨髓内输液装置在临床应用中具有重要的指导意义。
首先，它可以提供更快的药物吸收速度。
相比其他途径，如静脉注射或口服给药，骨髓内输液可以直接将药物输送到骨髓中，进而通过血液循环迅速传输至全身各个部位，提高药物的生物利用度和治疗效果。
其次，骨髓内输液装置还可以解决一些特殊医疗需求。
例如，对于化疗药物治疗骨髓瘤等血液系统疾病的患者，骨髓内输液可以更直接地作用于病变部位，提高治疗效果。
同时，对于需要长期静脉营养支持或输液治疗的患者，骨髓内输液可避免静脉途径的血管损伤和并发症，并可以持久稳定地输送所需液体和营养。
最后，骨髓内输液装置的使用需要严格遵守医疗操作规范。
医务人员应接受相关培训，熟悉装置的使用方法和注意事项，确保操作安全和有效。
此外，骨髓内输液装置的使用过程中，应严格监测患者的生命体征和输液情况，随时调整参数以保持准确输液和患者的舒适度。
总之，骨髓内输液装置是一项重要的医疗技术，其参数选择和正确使用对于患者的治疗效果至关重要。
医务人员应根据患者的具体情况，选择合适的参数，并严格按照操作规范进行操作，以实现最佳治疗效果和患者的安全舒适。
同时，不断加强对骨髓内输液装置的研究和应用，将进一步推动医学领域的发展和进步。
干细胞移植手术的手术器械和设备介绍
干细胞移植手术的手术器械和设备介绍干细胞移植是一种应用于医疗领域的先进技术，可用于治疗多种疾病。
干细胞具有自我复制和分化为不同细胞类型的特性，因此被视为能够修复受损组织和器官的有效方式。
在进行干细胞移植手术时，使用的器械和设备起着关键的作用。
本文将向您介绍干细胞移植手术中常用的手术器械和设备。
一、骨髓穿刺器骨髓是人体中最常用的干细胞移植来源之一。
骨髓穿刺器是用于从骨髓中抽取干细胞的关键器械。
该器械通常由一个细长的针管组成，可以通过骨骼进入骨髓腔。
骨髓穿刺器需要具备锐利的尖端，以确保在穿刺过程中对骨髓造成最小损伤。
同时，器械的外围部分需要提供充足的支撑，以便医生对器械进行稳定控制。
二、细胞分离器细胞分离器同样是干细胞移植过程中必不可少的器械之一。
细胞分离器用于将收集到的组织中的干细胞与其他细胞进行分离，以便纯化干细胞的群体。
细胞分离器常用的原理包括离心、过滤、沉降等。
通过离心过程，干细胞可以被分离到上清液中，然后进一步纯化。
细胞分离器需要具备高速、高效、稳定的特性，以确保分离过程的准确性和干细胞的纯度。
三、培养皿和细胞培养装置干细胞在移植前需要进行体外培养，以增加其数量和功能。
培养皿是干细胞培养过程中最基本的装置之一。
培养皿必须符合无菌的要求，并提供适宜的培养液和培养条件。
细胞培养装置通常由培养皿、培养箱和培养液等组成。
培养箱能够提供恒定的温度、湿度和二氧化碳浓度，以模拟人体内的环境。
培养装置的设计需要便于细胞的观察和操作，同时还需要保证培养环境的稳定性和安全性。
四、注射器和导管在进行干细胞移植手术时，注射器和导管用于将干细胞注入到患者的体内。
注射器负责收集、储存和注射干细胞，需要具备高精度、高灵敏度和可重复使用的特点。
导管是将干细胞输送到患者体内的关键工具，需要具备良好的弹性和耐受性，以确保干细胞的准确输送并避免引起其他损伤。
五、手术台和监测设备干细胞移植手术通常在无菌条件下进行。
手术台是干细胞移植手术的基本设备，需要提供舒适而稳定的操作平台。
干细胞移植手术的手术器械与设备介绍
干细胞移植手术的手术器械与设备介绍干细胞移植手术是一种应用于临床的先进技术，通过将干细胞引入患者身体，帮助修复受损组织或器官。
这项技术在治疗许多疾病，如白血病、骨髓疾病和免疫系统疾病等方面取得了重要的突破。
干细胞移植手术所需的各种器械与设备在整个手术过程中扮演着关键的角色，下面将介绍几种常见的器械与设备。
首先是骨髓穿刺器。
骨髓是干细胞的主要来源之一，因此在干细胞移植手术中，医生需要通过骨髓穿刺器从患者的骨髓中提取干细胞。
骨髓穿刺器通常由一个长而细的针和一个带有刃口的固定杆组成。
医生会将针插入骨髓腔，然后通过固定杆的帮助，转动并向下推送针尖以获取骨髓样本。
其次是干细胞分离设备。
在骨髓穿刺后，医生需要分离干细胞。
这时，干细胞分离设备就发挥了重要的作用。
干细胞分离设备主要包括离心机和分离柱。
离心机通过旋转分离样本中的不同成分，使干细胞沉淀到底部。
随后，医生使用分离柱进一步纯化干细胞样本，以确保获取的细胞数量和质量达到治疗所需的要求。
接下来是干细胞培养器。
经过分离和纯化，干细胞需要在实验室环境中进行培养，以增加数量并增强其治疗效果。
干细胞培养器是一种提供适宜环境的设备，通常包括培养基、曝气装置和恒温装置等。
培养器中的培养基提供了干细胞所需的营养和生长因子，曝气装置则通过气泡通入氧气，以提供细胞所需的氧气。
恒温装置保持温度稳定，以确保干细胞处于合适的生长温度。
最后是注射器。
一旦培养的干细胞达到治疗所需的数量和质量，它们需要被重新引入患者体内。
注射器是这一步不可或缺的工具。
常见的注射器包括手动注射器和自动注射器。
手动注射器由一个可以拖动的杆和一个可通过旋转操作杆控制药液注射量的柱塞组成。
自动注射器则通过一系列机械装置来控制药液的注射量和速度，使操作更加精确和准确。
这些都是干细胞移植手术中常用的器械与设备，它们在手术过程中发挥着至关重要的作用。
同时，随着科技的不断进步和临床需求的不断增加，相关器械与设备也在不断发展和改进。
机械骨髓穿刺针与手动骨髓穿刺针的比较：一项随机模拟试验说明书
Comparison of mechanical and manual bone marrow puncture needle for intraosseous access;a randomized simulation trialFumihiro Ohchi,Nobuyasu Komasawa *,Ryosuke Mihara and Toshiaki MinamiIntroductionThe European Resuscitation Council (ERC)cardiopul-monary resuscitation (CPR)guidelines emphasize the importance of minimizing chest compression interrup-tions to maximize coronary and cerebral perfusion pres-sure (Nolan et al.2010).The guidelines also suggest that skilled rescuers should be able obtain rapid and reliable airway or vascular access without interrupting chestcompressions (Neumar et al.2010;Deakin et al.2010).However,keeping definite vascular access is often diffi-cult for cardiopulmonary collapsed patients.When it is difficult or impossible to establish peripheral venous ac-cess,intraosseous route (IO)is considered as an alterna-tive to a central venous line (Blumberg et al.2008).Bone marrow puncture needle insertion for IO vascu-lar access is a standard procedure used,especially in paediatric resuscitation (Fiorito et al.2005),and IO devices has expanded its role to include resuscitation in patients of all ages (Glaeser 1993).However,it is*Correspondence:********************.ac.jpDepartment of Anesthesiology,Osaka Medical College,Daigaku-machi 2-7,Takatsuki,Osaka 569-8686,Japana SpringerOpen Journal©2015Ohchi et al.;licensee Springer.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (/licenses/by/4.0),which permits unrestricted use,distribution,and reproduction in any medium,provided the original work is properly credited.Ohchi et al.SpringerPlus (2015) 4:211 DOI 10.1186/s40064-015-0982-ysometimes difficult to perform IO rapidly and precisely with conventional manual bone marrow puncture needle.Furthermore,managing resuscitation can be challenging if the essential drugs or infusion cannot be administered (Vidal et al.1993).Recently,the mechanical bone marrow needle EZ-IO ™(EZ-IO,Teleflex,Pennsylvania,U.S.A.)has been devel-oped and its feasibility has been reported (Gillum &Kovar 2005;Cooper et al.2007).However,the utility for IO access with manual or mechanical bone marrow puncture needle has not been compared yet.As it is un-ethical to perform the validation of these needles in clin-ical settings first,we decided to perform the comparison between manual and mechanical bone marrow puncture needle utilizing simulation.The present study aimed to determine which of the two devices would improve IO access faster and defin-itely.To this end,we compared the performance of the manual and mechanical bone marrow puncture needle for adult,child and infant simulation.Materials and methodsThis study was judged as no need for registration by the institutional review board of Osaka Medical College be-cause this study does not include any patient or volunteer intervention.On 31th,January 2015,22anesthesiologists,who has never used bone marrow puncture needle,were recruited during peripheral nerve block training simulation course at Osaka Medical College.Selectedparticipants had 9.9±5.9years of clinical experience in anesthesia.The Proximal Tibia with skin patch®for adult simulation,Pediatric Tibia with skin patch®for 10-year-old child,and Tibia Fibula combination®simulated for 1year infant (Vidacare,San Antonio,U.S.A.)was used to perform man-ual or mechanical bone marrow needle puncture (Figure 1).These simulated tibia were made of polyurethane resin.Dickman bone marrow infusion needle®(Cook Medical,Indiana,U.S.A)were used for Manual bone marrow punc-ture needle,which is shown in Figure 2(adult 15.5G 3cm,child 16G 3cm,infant 15.5G 2.5cm).Mechanical bone marrow needle (Vidacare,San Antonio,U.S.A.)was used 25mm/15G for adult and 15mm/15G for child and infant simulation (Figure 1c).The simulated bone was placed on a hard,flat table.Each participant was given 5minutes for manual and mechanical bone marrow needle puncture.Each partici-pant was instructed to hold the manual or mechanical bone marrow needle and penetrate the bone safely and rapidly as possible,but not to penetrate to the other side of the bone.The instructor did not give any advice dur-ing the trial.Insertion started when the participant picked up the manual or mechanical bone marrow punc-ture needle and ended at the point of bone penetration.The puncture success or failure (could not penetrate the outer surface of the bone to inner lumen)was judged by the same person.Trial which was penetrated to the counter side of the bone was considered as failure.The(c)(b)25mm/15G15mm/15GInfant(1 year old)Pediatric (10 year old)AdultAdult 15.5 GPediatric 16 GInfant 18 Gadult,child,and infant tibias (a),and manual (b)and mechanical (c)bone marrow puncture needle.limitation is60seconds and if the participants could not keep IO within60seconds it is considered for failure. Insertion times were recorded for60second if they could not keep IO within this time period.At the end of the study,participants rated the difficulty of using both bone marrow needles for IO route keeping on a visual analog scale(VAS)from0mm(extremely easy)to100mm (extremely difficult)(Komasawa et al.2011).Results obtained from each trial were compared paired Students t test for insertion times and VAS,and Fisher’s exact test for the success rate.Data are pre-sented as mean±SD.P<0.05was considered statisti-cally significant.In this study,each participant perform manual and mechanical IO on three simulated bones(infant,child, adult).This increase the risk of learning curve effect. Thus,we performed this trial as a randomized cross-over design to minimize the learning curve effect.The order of six intervention was determined for each par-ticipant by random table number by computer(720pat-terns).Each participant performed six interventions in a different sequence(Komasawa et al.2013).Results of a ten-doctor preliminary study showed that the time required for successful insertion of the mechan-ical bone marrow puncture was approximately 5.2±1.3s.To detect a33%difference,we estimated that18 participants would be adequate for two independent groups,wherebyα=0.05andβ=0.2.ResultsIO insertion success with manual and mechanical bone marrow puncture needleNumbers of successful IO for both needles are displayed in Table1.In adult settings,with the manual bone mar-row needle,only3of22participants could succeed in the IO access keep,while all participants did in the mechanical bone marrow puncture needle.The success rate was significantly higher in mechanical bone marrow puncture needle trial than in manual one(P<0.001).In child and infant settings,all trials were successful in both manual and mechanical bone marrow punc-ture needles,which did not show significant difference (P=1.00).IO Insertion time with the manual and mechanical bone marrow puncture needleIO insertion times are shown in Figure2.In adult simula-tions,IO insertion took significantly longer with manual bone marrow puncture(54.8±15.8s)than without com-pressions(3.7±2.1s;P<0.001)(Figure2a).In child and infant simulations,the IO insertion time was significantly smaller in mechanical trials than in manual ones(child simulation;manual9.3±4.6s,mechanical2.2±0.8s, P<0.001,infant simulation;manual2.0±1.1s,mechanical 1.5±0.8s,P=0.003).VAS scores for IO insertion with manual and mechanical bone marrow puncture needleAs shown in Figure3,although the VAS score was not significantly higher with manual trials than in mechan-ical trials among the three simulations(adult simulation,Table1Bone marrow puncture success rates within1minute for manual and mechanical bone marrow puncture needleManual BMPN Mechanical BMPN P-value(Fisher’s exact test) Adult3/2222/22<0.001Child22/2222/22 1.00Infant22/2222/22 1.00BMPN:Bone marrow puncture needle.Values are presented as number of participants who achieved successful intubation/number of participants who attempted bone marrow puncture.P<0.001,child simulation,P<0.001,infant simulation P=0.006).DiscussionCurrent ERC-CPR guidelines emphasize the delivery of continuous chest compression with as few interruptions as possible,including pauses for vascular access,defibril-lation,or management efforts(Nolan et al.2010;Okada et al.in press).Several studies have shown that pro-longed interruption of chest compressions is associated with both decreased coronary and cerebral perfusion and reduced venous return to the heart,resulting in low survival rates and impaired post-resuscitation myocardial function(Deakin et al.2010).During cardiac arrest,after beginning chest compression and attempting defibrilla-tion for identified VF or pulseless VT,providers can establish intravenous(IV)or IO access.The primary purpose of IV/IO access during cardiac arrest is to pro-vide drug therapy.Several clinical studies reported data suggesting worsened survival for every minute that anti-arrhythmic drug delivery was delayed(Dorian et al. 2002;Kudenchuk et al.1999).IO cannulation provides access to a noncollapsible venous plexus,enabling drug delivery similar to that achieved by peripheral venous access at comparable doses.Various clinical trials suggest that IO access can be established efficiently;is safe and effective for fluid resuscitation,drug delivery,and blood sampling for la-boratory evaluation;and is attainable in all age groups (Guy et al.1993;Banerjee et al.1994;Stone et al.2007). It is reasonable for providers to establish IO access if IV access is not readily available in the ERC guidelines (Deakin et al.2010).The IO approach is a very fast,simple infusion tech-nique but non-negligible number of IO insertion failure even by trained emergency physicians remain(Simmons et al.1994;Moscati&Moore1990).One possible reason of high failure rate was caused mainly by the inability to control the path of the catheter.With manual bone mar-row puncture needle,penetration of the bone needs rela-tively massive force especially in adult bones and it is also difficult to confirm the correct placement of the needle(Horton&Beamer2008).Compared to manual bone puncture needle,the mechanical bone marrow puncture needle not only provide rapid puncture of the bone with powered drill but also prevent the excessive penetration of the bone with relatively short needles. Though there have been several reports about the utility of mechanical bone marrow puncture needle(Gillum& Kovar2005;Cooper et al.2007;Horton&Beamer2008), our simulation study is the first direct comparison between manual and mechanical bone marrow puncture needles.In our study,only three doctors could puncture adult bone within60seconds,while all participants could with mechanical one rapidly.It is often difficult to keep defin-ite IO access with mechanical bone marrow needle in adult patients during emergency.Our result suggests the utility of powered mechanical needle for IO access to puncture the hard bone rapidly and effectively,especially for adults.For child and infant simulations,although all participants could puncture the bone regardless of the needle type,the insertion time was significantly shorter in mechanical trial than in manual ones.As IO access is usually considered in emergency situations,it is import-ant to secure rapidly as possible.From the viewpoint of IO access puncture time,mechanical bone marrow nee-dle may be useful in various emergency situations of all ages.Furthermore,application of mechanical bone mar-row needle is useful in difficult intravenous access in critical care or perioperative management.This study has several limitations worth noting.First, the simulated tibia is different from that of real patients in some points.The simulated tibia do not contain other part of the human anatomy except tibia and surrounding structures.In real patients,we can confirm the back-flow of bone marrow blood.Utilizing a simulator withsurrounding anatomy and blood,we may evaluate the miss rates more clearly.Furthermore,we could not get simulated infant tibia with skin,which made the com-parison to child or adult difficult.Second,we could not simulate the efficacy of IO access evaluation during chest compression.Third,bone marrow puncture were performed on manikin,which leads to shorter airway intervention times than that required for actual patients (Komasawa et al.2014).Based on our simulation studies, clinical comparison of manual and mechanical bone marrow puncture needle is needed in the future study. We conclude that in simulations managed by anaes-thesiologists who had no clinical experiences with bone marrow puncture,the mechanical bone puncture needle performed better than the manual one for emergency IO route access.Competing interestThe authors have no competing interests with respect to this study.Financial support for the study was provided by our institution and department. Authors’contributionsFO and NK were involved in the study design,study implementation,data analysis,and manuscript preparation.RM was involved in study implementation and data analysis.TM was involved in the study design and manuscript preparation.All authors discussed the results and approved the final manuscript.Received:15March2015Accepted:17April2015ReferencesBanerjee S,Singhi SC,Singh S,Singh M(1994)The intraosseous route is a suitable alternative to intravenous route for fluid resuscitation in severelydehydrated children.Indian Pediatr31:1511–1520Blumberg SM,Gorn M,Crain EF(2008)Intraosseous infusion:a review of methods and novel devices.Pediatr Emerg Care24:50–6Cooper BR,Mahoney PF,Hodgetts TJ,Mellor A(2007)Intra-osseous access(EZ-IO) for resuscitation:UK military combat experience.J R Army Med Corps153:314–6 Deakin CD,Nolan JP,Soar J,Sunde K,Koster RW,Smith GB,Perkins GD(2010) European Resuscitation Council Guidelines for Resuscitation2010Section4.Adult advanced life support.Resuscitation81:1305–1352Dorian P,Cass D,Schwartz B,Cooper R,Gelaznikas R,Barr A(2002)Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation.N Engl J Med346:884–890Fiorito BA,Mirza F,Doran TM,Oberle AN,Cruz EC,Wendtland CL,Abd-Allah SA (2005)Intraosseous access in the setting of paediatric critical care.Pediatr Crit Care Med6:50–3Gillum L,Kovar J(2005)Powered intraosseous access in the prehospital setting: MCHD EMS puts the EZ-IO to the test.J Emerg Med Ser30:S24–5Glaeser PW(1993)Hellmich,Szewczuga D,Losek JD,Smith DS.Five-year experience in prehospital intraosseous infusions in children and adults.Ann Emerg Med 22:1119–224Guy J,Haley K,Zuspan SJ(1993)Use of intraosseous infusion in the pediatric trauma patient.J Pediatr Surg28:158–161Horton MA,Beamer C(2008)Powered intraosseous insertion provides safe and effective vascular access for paediatric emergency patients.Pediatr Emerg Care24:347–50Komasawa N,Ueki R,Fujii A,Samma A,Nakagawa M,Nishi S,Kaminoh Y(2011) Comparison of Laryngeal Mask Supreme®and Softseal®for airwaymanagement in Several Positions.J Anesth25:535–9Komasawa N,Ueki R,Yamamoto N,Nishi S,Kaminoh Y,Tashiro C(2013)Comparison of Pentax-AWS Airwayscope,Airtraq and Miller laryngoscope for tracheal intubation by novice doctors during infant cardiopulmonary resuscitation simulation:a randomized crossover trial.J Anesth27:778–80Komasawa N,Fujiwara S,Haba M,Mihara R,Minami parison of Quick Track and Melker for emergent invasive airway management during chestcompression:A crossover simulation trial.Eur J Anaesthesiol.2014Aug8.[Epub ahead of print].Kudenchuk PJ,Cobb LA,Copass MK,Cummins RO,Doherty AM,Fahrenbruch CE, Hallstrom AP,Murray WA,Olsufka M,Walsh T(1999)Amiodarone forresuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.N Engl J Med341:871–878Moscati R,Moore GP(1990)Compartment syndrome with resultant amputation following intraosseous infusion.Am J Emerg Med8:470–1Neumar RW,Otto CW,Link MS,Kronick SL,Shuster M,Callaway CW,Kudenchuk PJ,Ornato JP,McNally B,Silvers SM,Passman RS,White RD,Hess EP,Tang W, Davis D,Sinz E,Morrison LJ(2010)Part8:adult advanced cardiovascular life support:2010American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation122:S729–767 Nolan JP,Soar J,Zideman DA,Biarent D,Bossaert LL,Deakin C,Koster RW,Wyllie J, Böttiger B(2010)European Resuscitation Council Guidelines for Resuscitation 2010:Section1.Executive summary.Resuscitation81:1219–1276Okada D,Komasawa N,Fujiwara S,Minami parison of tube-guided and guideless videolaryngoscope for tracheal intubation during chest compres-sion in a manikin:a randomized crossover trial.J Anesth in press Simmons CM,Johnson NE,Perkins RM,van Stralen D(1994)Intraosseous extravasation complication reports.Ann Emerg Med23:363–73Stone MB,Teismann NA,Wang R(2007)Ultrasonographic confirmation of intraosseous needle placement in an adult unembalmed cadaver model.Ann Emerg Med49:515–9Vidal R,Kissoon N,Gayle M(1993)Compartment syndrome following intraosseous infusion.Paediatrics91:1201–2。
骨髓腔输液在急诊急救中的应用
• 多巴胺
• 维库铵
• 美托洛尔
• 异丙嗪
• 葡萄糖酸钙 • 麻黄碱
• 氢吗啡酮
• 咪达唑仑
• 丙泊酚
• 盐酸头孢吡肟 • 肾上腺素
• 胰岛素
• 美维库铵
• 普萘洛尔
并发症
➢液体渗漏皮下或骨膜下 ➢骨髓炎 ➢骨室筋膜综合症 ➢皮下脓肿 ➢脂肪栓塞 ➢胫骨骨折 ➢皮肤坏死
并发症——关于骨内通路的感染
欧美国家对骨髓腔内输液技术的培训较为重视 ✓ 英国有559家医疗单位的医护人员接受过骨髓腔内输液知识 与技能的培训 ✓ 美国90%以上的医院均配备骨髓腔内输液装置
国内大多数医院尚未开展骨髓腔穿刺输液技术 ✓ 备有骨髓腔内输液装置的医院不足10% ✓ 医护人员对骨髓腔内输液的认知度存在严重不足 ✓ 对骨髓腔内输液的信任度较差
成人/青少年/胖儿童: 髌骨下缘约3cm，胫骨粗隆 内侧2cm处的胫骨平坦处
新生儿/婴幼儿/儿童: 伸直下肢，髌骨下缘约1cm处，胫骨 粗隆内侧约1厘米处的胫骨平坦处
胫骨远端定位 内踝上
成人: 内踝上3cm，约2横指
婴幼儿/儿童: 内踝上1-2cm，约1横指
疼痛的管理
药物
2%无防腐剂和肾上腺素的利多卡因
3 确认位置 拔除导芯，连接包装内专用连接管，回抽可见骨髓内容物
操作流程
4 冲洗 5 固定
连接注射器用10ml（儿童2~5ml）的生理盐水快速冲洗
目的：去除骨髓腔内的骨髓和纤维蛋白，以保证有效输液速度
6 输液
1. 连接加压输液袋，压力设置300mmHg（儿童150） 2. 输液前后进行冲洗以保证所有药物都进入血管
另一只手的尺侧在上 臂，侧面沿中线放置
将双手拇指放在 患者上肢上，沿 距双手尺侧中线 由下至上深触诊 定位穿刺点
骨髓液吸取操作方法
骨髓液吸取操作方法
骨髓液吸取是一种医疗操作，用于获取骨髓内的液体样本进行病理学和血液疾病的诊断。
下面是一般的骨髓液吸取操作方法：
1. 准备工作：患者应背部平躺，暴露腰背部骨髓穿刺点，通常是腰椎的第二和第三间隙。
穿刺部位应清洁消毒，可能需要局部麻醉。
2. 确定穿刺点：医生会通过触诊和透视等方法确定穿刺点，确保针头进入正确的位置。
3. 局部麻醉：在穿刺点附近进行局部麻醉，以减轻患者的疼痛感。
4. 穿刺操作：医生使用一把特殊的骨髓穿刺针穿刺皮肤、肌肉和骨骼，直到进入到骨髓腔。
在这个过程中，医生可能需要透视或使用超声波来确保针头进入准确位置。
5. 吸取骨髓液：一旦针头进入骨髓腔，医生会将一支注射器或连接到采样管的抽吸器连接到骨髓穿刺针上，以吸取骨髓液样本。
6. 封闭穿刺点：骨髓液采集完毕后，医生会从穿刺点拔出骨髓穿刺针，并对穿刺点进行适当处理，可能包括压迫止血或缝合。
7. 处理和送检：采集到的骨髓液样本应立即送往实验室进行检测和分析。
需要注意的是，骨髓液吸取是一种有一定风险的操作，需要由经验丰富的医务人员进行，并且在严格的无菌条件下进行，以避免感染等并发症的发生。
骨髓液吸取前，患者可能需要进行一些特殊的检查和评估，以确保其适合进行这项操作。
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When Not?
Risks 风险
Contraindications 禁忌症
• Osteomyelitis 骨髓炎 • Compartment syndrome 骨筋膜综合症
• Twice in the same limb 同一部位不 能做两次 • Bone disease 穿刺部附件有骨疾病 • Failure to locate anatomical landmark 畸形 • Trauma to the bone 穿刺部位骨折
大规模意外事故
Intraosseous 骨髓腔通道 IO
Because every second counts 挽救生命，争分夺秒
AHA
Common specific guidelines:
• After a failure in two I.V attempts. 2次IV失败 • If it takes more than 90 seconds to find I.V access. 90 秒内无法建立静脉通路
PerSys Medical Group
SAVING LIVES
Life threatening conditions:
• • • • • • • • • Cardiac Arrest 心脏骤停 all kinds of Shock 休克 Dehydration 脱水 Respiratory failure (CHF, COPD etc..) 呼吸衰竭 Trauma 外伤 Drugs O.D. 药物过量过敏 Burns 烧烫伤 Epileptic Seizures 癫痫发作 Diabetic Emergencies 突发糖尿病
Shoulder Anatomy
肱骨大结节 肩峰 喙突
Acromion – Coracoid approach (3):
In the middle of that line draw another line down, toward the Elbow. 喙突与肩峰连线中点向 te the arm ?
1. To protect nerves, tendons and blood vessels. 避免伤及神经，筋膜和深部血管。 2. To maximum expose the GT. 尽可能暴露肱骨 大结节
How?
How?
How?
How?
What (is I.O)?
通过穿过骨皮质层进入骨髓腔从而联通血管系统。
当静脉穿刺输液失败时，骨髓腔穿刺输液应该应用于成人和儿童。
Where?
Where?
Positioning of the patient
• Position the patients hand on top of the Umbilicus – this is called Adduction.掌心置于肚脐部，手臂 内收尽量贴近身体。 • Try to keep patient laying straight on his back with arm close as possible to body- this is called a Supine position 患者上半身直立。