Significance of intraosseous infusion in paediatric anaesthesia - A web-based survey

Background: The aim of the present study was to evaluate the significance of intraosseous infusion in German-speaking anaesthesia units providing paediatric care in the year 2009. Methods: Via an online questionnaire the number of children treated, the nature of intraosseous infusion material, storage, indications in paediatric anaesthesia, experience and teaching concepts were investigated. Results: Out of a total of 270 units approached, 53 (20%) completed and returned the questionnaire. Intraosseous infusion is available at all these facilities (74% store the necessary material in the OR facility itself). Within the last 12 months the technique has been used in 39 units (74%), mostly by the EMS, in 77 % of the cases problem-free (n=30). Dislocation proved to be the most common (n=8), osteomyelitis and bone fracture (each n=1) the worst, complication encountered. In addition to life-threatening situations, further indications were "urgent surgical situations (i.e. ileus)" (42%, n=22), and in otherwise healthy "routine patients after inhalative induction" (13%, n=7) in a very difficult venous access situation. Specific structured training is implemented by 87 % of the units (n=46). Conclusion: The low response rate implies a still low level of intraosseous infusion use in German paediatric anaesthesia units. Our data do, however, indicate that among the units that returned the questionnaire, intraosseous infusion is an accepted and important alternative and emergency technique in paediatric anaesthesia.