One afternoon I passed through the emergency room and noticed two doctors hovering over a patient attempting to get intravenous access. As in many of the emergency cases, the patient’s circulation was poor. While one doctor was attempting jugular access, I suggested inserting an intraosseous needle.
Having experience, albeit a year ago when I was last in Sierra Leone in the outpatient setting, I was handed a standard 19-gauge needle and attempted to get access into the tibia of the left leg. Using some force and a screwing motion I felt the needle push through the bone and within a minute or two the needle was in place. I quickly withdrew some bone marrow content, confirming the needle was in the cavity. I then flushed the needle with normal saline to reconfirm the position. Thankfully, a few seconds later the patient received dextrose and a normal saline bolus through the needle in the tibia. What a relief. Now, I could only hope that the insertion of the needle had saved this patient’s life. Since the condition on arrival was very poor, only time would tell what the outcome would be.
I checked up on the patient every day to assess the general condition and was glad to see a little bit of improvement each time I checked. The patient was soon transferred to a general ward and finally, after about a week, discharged home in good condition.
Fortunately intraosseous access did save this patient’s life. And although many people are not as familiar with this procedure, I would definitely advocate that it should be done more often. Contrary to what many people may think, it is actually not a difficult procedure to perform and as long as a sterile environment is created, the doctor is fairly confident and a large bore needle is available, it can be done successfully within a few minutes. The chance of complications is very small if a sterile technique is used and as long as the needle is removed after a few hours. In my opinion, the benefits of this procedure far outweigh the risks and in an emergency setting it is an ideal way of ensuring a quick delivery of fluids, blood, and medication. I am definitely in favor of intraosseous access.
Sandra Lako is a doctor from the Netherlands who previously spent four and a half years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.