Resuscitation with intraosseous lines in neonatal units.

Two infants on the neonatal unit aged 143 days and 47 days with difficult venous access were successfully resuscitated from episodes of coliapse using the intraosseous route. (Arch Dis Child 1993;68:324-325) Intraosseous resuscitation of babies and infants is taught to residents in North America in the paediatric advanced life support course.1 No such formal training is widely available in Great Britain. Residents are encouraged to site intraosseous lines in an arrest if conventional venous access has not been established within one minute. The chosen route is in to the medial tibial plate (figure). The needle is simply inserted using a screwing action at right angles to the bone surface, when the marrow cavity is entered the needle gives. Correctly positioned, the needle is very stable and fluid can be infused without resistance. Case reports Recently two babies on our neonatal unit have collapsed and venous access was impossible. Both had had multiple peripheral cannulations and previously attempted central catheterisation.