Compartment Syndrome of the Leg After Intraosseous Infusion: Guidelines for Prevention, Early Detection, and Treatment

Abstract not available. Introduction provided instead.

Obtaining adequate vascular access in the multiply injured or critically ill pediatric patient can be very difficult. Options for gaining access to the venous circulation include peripheral percutaneous cannulation, intraosseous (IO) infusion, percutaneous central venous access, and peripheral venous cutdown. If percutaneous access is not achieved after 2 attempts, consideration should be given to IO infusion or peripheral venous cutdown. Percutaneous central venous cannulation is not routinely used for primary access for resuscitation in adult trauma patients and should not be used as such in pediatric trauma patients.

IO infusion is an expedient, safe, and reliable method of administering fluids and medications during resuscitation.^1-3 However, potential complications associated with IO infusion include osteomyelitis, cellulitis, fracture at IO-line site, compartment syndrome, and fat embolism.^4-10

Although compartment syndrome is a rare complication of IO-line placement, this case report illustrates that it can occur. This report also emphasizes that, with proper technique, attention to detail, and serial monitoring of the involved limb, compartment syndrome and other potential complications can be avoided. We have obtained the patient’s guardian’s informed, written consent to publish the case report.