- -Where is the potentially largest “landing area” for the needle, sorted by age group?
- -Of the various systems, are individual systems better or worse suited for the corresponding access due to their design?
- -The proximal tibia is currently usually recommended as the standard site for intraosseous access,1as the literature to date has described mostly poorer results in alternative sites.2However, these studies have been conducted on adults and are therefore not necessarily representative for infants and children. Our study cannot clarify this either, since in almost all cases the proximal tibia was chosen as the access site (only two cases with a different access site; in both cases malpositions of the needle3).
- -In our study, the malpositions in which the corticalis was perforated on both sides were the minority of malpositions (31% in infants and 11% in children3). Thus, not only the width of the medullary cavity seems to be decisive for success. This should be taken into account when revising the procedure.
- -As already described in the letter, the changed risk profile of extravasations and other procedure related risks depending on the puncture site should not be ignored.1However, depending on the severity and life-threatening nature of the underlying disease, a higher risk may be acceptable.
Conflict of interest statement
- Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use.Anesth Analg. 2010; 110: 391-401
- A randomized cadaver study comparing first-attempt success between tibial and humeral intraosseous insertions using NIO device by paramedics: a preliminary investigation.Medicine (Baltimore). 2016; 95: e3724
- Intraosseous needles in pediatric cadavers: rate of malposition.Resuscitation. 2019; 145: 1-7