Intraosseous infusion rates under high pressure: a cadaveric comparison of anatomic sites

When traditional vascular access methods fail, emergency access through the intraosseous (IO) route can be lifesaving. Fluids, medications, and blood components have all been delivered through these devices. We sought to compare the performance of IO devices placed in the sternum, humeral head, and...

Full description

Saved in:

Bibliographic Details
Published in:	The journal of trauma and acute care surgery Vol. 78; no. 2; pp. 295 - 299
Main Authors:	Pasley, Jason, Miller, Catriona H T, DuBose, Joseph J, Shackelford, Stacy A, Fang, Raymond, Boswell, Kimberly, Halcome, Chuck, Casey, Jonathan, Cotter, Michael, Matsuura, Michael, Relph, Nathaniel, Tarmey, Nicholas T, Stein, Deborah M
Format:	Journal Article
Language:	English
Published:	United States 01-02-2015
Subjects:	Adolescent Adult Aged Cadaver Emergencies Female Humans Humerus Infusions, Intraosseous - instrumentation Infusions, Intraosseous - methods Male Middle Aged Pressure Sternum Tibia
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	When traditional vascular access methods fail, emergency access through the intraosseous (IO) route can be lifesaving. Fluids, medications, and blood components have all been delivered through these devices. We sought to compare the performance of IO devices placed in the sternum, humeral head, and proximal tibia using a fresh human cadaver model. Commercially available IO infusion devices were placed into fresh human cadavers: sternum (FAST-1), humeral head (EZ-IO), and proximal tibia (EZ-IO). Sequentially, the volume of 0.9% saline infused into each site under 300 mm Hg pressure over 5 minutes was measured. Rates of successful initial IO device placement and subjective observations related to the devices were also recorded. For 16 cadavers over a 5-minute bolus infusion, the total volume of fluid infused at the three IO access sites was 469 (190) mL for the sternum, 286 (218) mL for the humerus, and 154 (94) mL for the tibia. Thus, the mean (SD) flow rate infused at each site was as follows: (1) sternum, 93.7 (37.9) mL/min; (2) humerus, 57.1 (43.5) mL/min; and (3) tibia, 30.7 (18.7) mL/min. The tibial site had the greatest number of insertion difficulties. This is the first study comparing the rate of flow at the three most clinically used adult IO infusion sites in an adult human cadaver model. Our results showed that the sternal site for IO access provided the most consistent and highest flow rate compared with the humeral and tibial insertion sites. The average flow rate in the sternum was 1.6 times greater than in the humerus and 3.1 times greater than in the tibia.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2163-0755 2163-0763
DOI:	10.1097/TA.0000000000000516