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Drozd A, Wolska M, Szarpak L. Intraosseous vascular access in emergency and trauma settings: a comparison of the most universally used intraosseous devices. Expert Rev Med Devices 2021; 18:855-864. [PMID: 34325586 DOI: 10.1080/17434440.2021.1962287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Obtaining successful vascular access is an essential component of the emergency and trauma setting. The modern practice of medicine advocates IO access for patients in a critical condition, especially when IV access is problematic or unobtainable. Various medical devices allowing for IO access have been coined and used in the management of critical patients.Areas covered: This study aims to review the literature regarding different intraosseous devices used to obtain vascular access (Bone Injection Gun (BIG), EZ-IO, NIO, Jamshidi, and First Access for Shock and Trauma (FAST-1) and discuss their clinical and experimental role in the emergency and trauma settings.Expert opinion: The development of medical technology contributes to an increasing number of intraosseous devices facilitating vascular access in challenging scenarios, including cardiopulmonary resuscitation, anaphylactic, or hypovolemic shock. Each of these devices provides an effective route for fluid resuscitation, drug delivery, laboratory evaluation, and shortening the timeframe for established vascular access, provided that the person obtaining the access is acquainted with the use of the device.
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Affiliation(s)
- Anna Drozd
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marta Wolska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
| | - Lukasz Szarpak
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.,Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland.,Outcomes Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
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Overbey JK, Kon AA. Dermal Abrasion Experienced as an Adverse Effect of the EZ-IO(®). J Emerg Med 2015; 50:e7-10. [PMID: 26603361 DOI: 10.1016/j.jemermed.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/26/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2007, an update was released to the pediatric and neonatal septic shock guidelines, which emphasized early use of therapies, specifically, first-hour fluid resuscitation and inotrope therapy. This has led to increased use of intraosseous (IO) access as a source of vascular access. Previously, IO access could be obtained only via a manual IO placement. New semi-automatic devices, such as EZ-IO(®) (Vidacare, Shavano Park, TX), allow for safer and quicker IO access. Data support the use of semi-automatic devices during the acute resuscitation period. CASE REPORT The patient was a 7-month old girl with VACTERL association (Vertebral defects, Anal atresia, Cardiac defects, Tracheo-Esophageal fistula, Renal anomalies, Limb abnormalities) and complex past medical history. The patient experienced a "choking episode," which led to subsequent apnea and cyanosis. The patient presented in shock to a local pediatric emergency department. After multiple unsuccessful intravenous line attempts, IO access was obtained using the EZ-IO(®). Once in the pediatric intensive care unit with venous access, the IO device was removed and the site had "red bulls-eye target shape" damage to the skin, which appeared consistent with the EZ-IO(®) flange. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: IO device use is increasing due to the most recent pediatric and neonatal septic shock guidelines, which emphasize first-hour fluid resuscitation and inotrope therapy. It is vital that emergency physicians be aware of the adverse effects of semi-automatic IO devices, including dermal abrasion, which has not been reported previously. With proper training and familiarity, it is possible to avoid dermal abrasion as an adverse effect of the semi-automatic IO device.
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Affiliation(s)
- Jamie K Overbey
- Department of Pediatrics, Naval Medical Center San Diego, San Diego, California
| | - Alexander A Kon
- Department of Pediatrics, Naval Medical Center San Diego, San Diego, California; Department of Pediatrics, University of California San Diego, San Diego, California
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Goldschalt C, Doll S, Ihle B, Kirsch J, Mutzbauer TS. Intraosseous vascular access through the anterior mandible--a cadaver model pilot study. PLoS One 2014; 9:e112686. [PMID: 25405476 PMCID: PMC4236097 DOI: 10.1371/journal.pone.0112686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/10/2014] [Indexed: 11/19/2022] Open
Abstract
Background Several insertion sites have been described for intraosseous puncture in cases of emergencies when a conventional vascular access cannot be established. This pilot study has been designed to evaluate the feasibility of the mandibular bone for the use of an intraosseous vascular access in a cadaver model. Methodology/Principal Findings 17 dentistry and 16 medical students participating in a voluntary course received a short introduction into the method and subsequently used the battery powered EZ-IO system with a 15 mm cannula for a puncture of the anterior mandible in 33 cadavers. The time needed to perform each procedure was evaluated. India ink was injected into the accesses and during the anatomy course cadavers were dissected to retrace the success or failure of the puncture. Dental students needed 25.5±18.9(mean±standard deviation)s and medical students 33±20.4 s for the procedure (p = 0.18). Floor of mouth extravasation occurred in both groups in 3 cases. Success rates were 82 and 75% (p = 0.93). Conclusions/Significance Despite floor of mouth extravasation of injected fluid into a mandibular intraosseous access might severely complicate this procedure, the anterior mandible may be helpful as an alternative to other intraosseous and intravenous insertion sites when these are not available in medical emergencies.
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Affiliation(s)
- Christin Goldschalt
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
| | - Sara Doll
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
| | - Brit Ihle
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
| | - Joachim Kirsch
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
| | - Till Sebastian Mutzbauer
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
- Mutzbauer&Partner, Maxillofacial Surgery and Anesthesiology, Zuerich, Switzerland
- * E-mail:
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La perfusion intraosseuse chez l’adulte. ACTA ACUST UNITED AC 2013; 32:347-54. [DOI: 10.1016/j.annfar.2013.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 02/28/2013] [Indexed: 11/20/2022]
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Abstract
AbstractBackgroundAlthough the majority of Australian intensive care paramedics use the manual intraosseous infusion technique (MAN-IO), several other semiautomatic devices now are available, such as the bone injection gun (BIG) and the semiautomatic intraosseous infusion system (EZ-IO). Given the choice of devices now available, questions have been raised regarding success rates, accuracy, decay of skills, and adverse events.ObjectivesReview the literature regarding the use of intraosseous (IO) devices in the prehospital setting.MethodsSelected electronic databases (Medline, Embase, and CINAHL) were searched, and a hand search was conducted for grey-literature that included studies from the commencement of the process to the end of May 2010. Inclusion criteria were any study reporting intraosseous insertion and/or infusion (adult and pediatric) by paramedics in the prehospital setting.FindingsThe search located 2,100 articles; 20 articles met the inclusion criteria. The review also noted that use of IO access (regardless of technique) offers a safe and simple method for gaining access to the patients’ vascular system. A number of studies found that the use of semiautomatic devices offers better and faster intraosseous access compared with the use of manual devices, and also were associated with fewer complications. The findings also suggest that the use of semiautomatic devices can reduce insertion times and the number of insertion attempts when contrasted with the use of manual insertion techniques. Despite these findings, statistically no specific IO device has proven clinical superiority.ConclusionWhile manual IO techniques currently are used by the majority of Australian paramedics, the currently available evidence suggests that semiautomatic devices are more effective. Further research, including cost-benefit analyses, is required at a national level to examine skill acquisition, adverse effects, and whether comparative devices offer clinically significant advantages.OlaussenA, WilliamsB. Intraosseous access in the prehospital setting: literature review. Prehosp Disaster Med.2012;27(5):1-5.
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Abstract
Intraosseous cannulation is an increasingly common means of achieving vascular access for the administration of fluids and medications during the emergent resuscitation of both paediatric and adult patients. Improved tools and techniques for intraosseous vascular access have recently been developed, enabling the healthcare provider to choose from a wide range of devices and insertion sites. Despite its increasing popularity within the adult population, and decades of use in the paediatric population, questions remain regarding the safety and efficacy of intraosseous infusion. Although various potential complications of intraosseous cannulation have been theorized, few serious complications have been reported. This article aims to provide a review of the current literature on intraosseous vascular access, including discussion on the various intraosseous devices currently available in the market, the advantages and disadvantages of intraosseous access compared to conventional vascular access methods, complications of intraosseous cannulation and current recommendations on the use of this approach.
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Affiliation(s)
- James H Paxton
- Department of Emergency Medicine, Detroit Medical Center, Detroit, MI, USA
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Current advances in intraosseous infusion – A systematic review. Resuscitation 2012; 83:20-6. [DOI: 10.1016/j.resuscitation.2011.07.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 07/11/2011] [Accepted: 07/14/2011] [Indexed: 11/22/2022]
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Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: A prospective, randomized study. Resuscitation 2010; 81:994-9. [PMID: 20434823 DOI: 10.1016/j.resuscitation.2010.03.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/23/2010] [Accepted: 03/29/2010] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Current guidelines recommend intraosseous (IO) vascular access in adults if peripheral venous access is unavailable. Most available data derive from children, animal models, cadaver studies or the prehospital setting. Therefore we compared two different IO access devices in adults under resuscitation in the hospital setting. PATIENTS AND METHODS This prospective, randomized clinical study compared two different IO access devices in adults (>/=18 years of age) under trauma or medical resuscitation admitted to our emergency department with impossible peripheral venous access. Each adult was randomized to either spring-loaded BIG Bone Injection Gun or battery-powered EZ-IO. Outcome measures included success rates on first attempt, procedure times and complications. RESULTS Forty consecutive adults under resuscitation were enrolled. Twenty patients received the BIG, another twenty patients the EZ-IO. Over all success rate on first attempt was 85% and mean procedure time 2.0min+/-0.9. Comparing the two devices, success rate on first attempt was 80% for the BIG versus 90% for the EZ-IO and mean procedure time was 2.2min+/-1.0 for the BIG versus 1.8min+/-0.9 for the EZ-IO. The differences between both IO devices were not statistically significant. No other relevant complications like infection, extravasation or bleeding were observed. CONCLUSIONS IO vascular access was a reliable and safe method to gain rapid vascular access for in-hospital adult emergency patients under resuscitation. Further studies are necessary regarding comparative effectiveness of different IO devices.
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Hartholt KA, van Lieshout EMM, Thies WC, Patka P, Schipper IB. Intraosseous Devices: A Randomized Controlled Trial Comparing Three Intraosseous Devices. PREHOSP EMERG CARE 2009; 14:6-13. [DOI: 10.3109/10903120903349861] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Leidel BA, Kirchhoff C, Bogner V, Stegmaier J, Mutschler W, Kanz KG, Braunstein V. Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study. Patient Saf Surg 2009; 3:24. [PMID: 19814822 PMCID: PMC2764565 DOI: 10.1186/1754-9493-3-24] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 10/08/2009] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND For patients' safety reasons, current American Heart Association and European Resuscitation Council guidelines recommend intraosseous (IO) vascular access as an alternative in cases of emergency, if prompt venous catheterization is impossible. The purpose of this study was to compare the IO access as a bridging procedure versus central venous catheterization (CVC) for in-hospital adult emergency patients under resuscitation with impossible peripheral intravenous (IV) access. We hypothesised, that CVC is faster and more efficacious compared to IO access. METHODS A prospective observational study comparing success rates and procedure times of IO access (EZ-IO, Vidacare Corporation) versus CVC in adult (>/=18 years of age) patients under trauma and medical resuscitation admitted to our emergency department with impossible peripheral IV catheterization was conducted. Procedure time was defined from preparation and insertion of vascular access type until first drug or infusion solution administration. Success rate on first attempt and procedure time for each access route was evaluated and statistically tested. RESULTS Ten consecutive adult patients under resuscitation, each receiving IO access and CVC, were analyzed. IO access was performed with 10 tibial or humeral insertions, CVC in 10 internal jugular or subclavian veins. The success rate on first attempt was 90% for IO insertion versus 60% for CVC. Mean procedure time was significantly lower for IO cannulation (2.3 min +/- 0.8) compared to CVC (9.9 min +/- 3.7) (p < 0.001). As for complications, failure of IO access was observed in one patient, while two or more attempts of CVC were necessary in four patients. No other relevant complications, like infection, bleeding or pneumothorax were observed. CONCLUSION Preliminary data demonstrate that IO access is a reliable bridging method to gain vascular access for in-hospital adult emergency patients under trauma or medical resuscitation with impossible peripheral IV access. Furthermore, IO cannulation requires significantly less time to enable administration of drugs or infusion solutions compared to CVC. Because CVC was slower and less efficacious, IO access may improve the safety of adult patients under resuscitation in the emergency department.
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Affiliation(s)
- Bernd A Leidel
- Department of Emergency Medicine, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- Helicopter Emergency Medical Service Christoph 31, ADAC Luftrettung air rescue services, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Viktoria Bogner
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Julia Stegmaier
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Wolf Mutschler
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Volker Braunstein
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
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Shavit I, Hoffmann Y, Galbraith R, Waisman Y. Comparison of two mechanical intraosseous infusion devices: A pilot, randomized crossover trial. Resuscitation 2009; 80:1029-33. [DOI: 10.1016/j.resuscitation.2009.05.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/15/2009] [Accepted: 05/28/2009] [Indexed: 11/16/2022]
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Luck RP, Haines C, Mull CC. Intraosseous access. J Emerg Med 2009; 39:468-75. [PMID: 19545966 DOI: 10.1016/j.jemermed.2009.04.054] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 01/30/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vascular access is of paramount importance in the care of the critically ill patient. When central or peripheral intravenous access cannot be accomplished in a timely manner, intraosseous access and infusion is a rapid and safe alternative for the delivery of fluids, medications, and blood products. The resurgence of the use of intraosseous access in the 1980s led to the development of new methods and devices that facilitate insertion. OBJECTIVES This article discusses general indications, contraindications, and complications of intraosseous access and infusion, focusing on new devices and their insertion. DISCUSSION Current research is focused on product innovation and improving drug delivery using intraosseous autoinjectors, finding new anatomic sites for placement, and expanding the use of different intraosseous devices to the adult population. CONCLUSIONS/SUMMARY New, improved intraosseous systems provide health care providers with choices beyond traditional manual intraosseous access for administering fluids.
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Affiliation(s)
- Raemma P Luck
- Department of Pediatrics and Emergency Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA
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Ong MEH, Ngo ASY, Wijaya R. An Observational, Prospective Study to Determine the Ease of Vascular Access in Adults Using a Novel Intraosseous Access Device. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n2p121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction: Intraosseous access is an alternative to conventional intravenous access when access is difficult or impossible in the adult population. The EZ-IOTM is a novel intraosseous access device designed for use in adults, utilising a powered driver.
Materials and Methods: A prospective, observational study involving a convenience sample of 25 medical students, physicians and nursing staff recruited as study subjects to secure intraosseous access using the EZ-IOTM powered drill device, on a bone model.
Results: Twenty-three (92%) of the 25 study subjects required only 1 attempt at placing the EZ-IOTM. There were 24 (96%) successful placements of the EZ-IOTM. The average time taken to place the EZ-IOTM was 13.9 seconds. Twenty (87%) of 23 participants reported easier placement with the EZ-IOTM than an intravenous cannula. The average time taken for the physicians, nursing staff and medical students was 3.71 (± SD 1.70) seconds, 7.88 (± SD 4.02) seconds and 33.7 (24.5), respectively. Overall mean difficulty of insertion score (VAS) was 3.1 (± SD 1.9).
Conclusion: The intraosseous access device evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department.
Key words: Emergency department, Intravascular infusion, Resuscitation, Shock
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Abstract
Neonatal health care providers are fortunate that the umbilical cord generally provides easy intravenous (IV) access for newborn patients. Outside of the immediate newborn period, however, it may be impossible to obtain peripheral or umbilical IV access in critically ill newborns. Intraosseous (IO) infusion is not widely used in the neonatal population, but is a viable option when IV access cannot be established quickly. This article examines IO infusion devices and placement sites and addresses assessment and care of the infant receiving IO fluids and medications.
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The Use of a Powered Device for Intraosseous Drug and Fluid Administration in a National EMS: A 4-Year Experience. ACTA ACUST UNITED AC 2008; 64:650-4; discussion 654-5. [DOI: 10.1097/ta.0b013e31814db2a6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This is a review article of intraosseous infusion methods and devices.
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Abstract
OBJECTIVE To determine which model best simulates the actual IO procedure in children. METHODS Forty emergency and critical care physicians with significant IO experience (6 or more IO procedures) in real children were recruited at 4 academic centers. Study subjects were provided with a kit containing 15 gauge IO needles and 5 IO models; a plastic IO doll leg (PL), a turkey femur/thigh (TT), a turkey tibia/drumstick (TD), a chicken femur/thigh (CT), and a pork rib (PR). Study participants scored the similarity of the bone model to that of placing an IO in a child (0 = no experience, 1 = perfect simulation, 2 = excellent, but not perfect, 3 = good, 4 = moderate, 5 = poor) and the hardness of the bone (H = too hard, J = just right, S = too soft) for each age group (preterm, newborn, 1-4 months, 5-12 months, 12-36 months, 3-6 years, 6-12 years, and >12 years old) of whom they had previous experience. Mean scores were calculated and compared to determine which model provided the best simulation. RESULTS After excluding zero scores, overall mean scores for the CT, TD, TT, PL, and PR models were 3.2, 3.3, 3.3, 3.3, and 4.4 (P < 0.001), respectively. The pork rib had the worst score in all age groups, while the other 4 models had roughly similar scores. All models had substantial percentages of the models classified as too hard or too soft, except for the pork rib, which was predominantly too hard. CONCLUSIONS For IO research and teaching purposes, bone models should be age appropriate. This study suggests that there is great variability in preference with the chicken, turkey, and plastic models.
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Affiliation(s)
- Floyd S Ota
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, USA
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Boyd RJ, Schutz J, Stuart P. Comparison of two needle types for intraosseus access in an animal model. Emerg Med Australas 2003; 15:330-3. [PMID: 14631699 DOI: 10.1046/j.1442-2026.2003.00487.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study was designed to investigate the success rate, time for insertion and perceived difficulty in gaining intraosseus access in a porcine-derived animal model. The model was selected to have bone characteristics similar to human adult bone. Prehospital care personnel used two varieties of commercially available intraosseus needles, Cook Paediatric Intraosseus Insertion Needles and Cook Osteo-site needles. METHODS Sixteen ambulance paramedic trainees were trained to use both of two intraosseus needle types. They were timed from start of insertion attempt to successful insertion and asked to score perceived difficulty of intraosseus needle insertion using a modified Likert scale. RESULTS Sixteen of 16 (100%) of the insertions with the Cook Osteo-site needle were successful. Eleven of 16 (69%) insertions with the Cook Paediatric Intraosseus Insertion needle were successful. There was a statistically significant difference between the two groups (P = 0.033). The Cook Osteo-site needle was perceived to be significantly easier to use than the Cook Paediatric Intraosseus Insertion needle (P = 0.0085) and there was a non-significant trend to shorter insertion times for the Cook Osteo-site needle. CONCLUSIONS Use of intraosseus needles to gain access in an animal model is possible. The use of the Cook Osteo-site needle is associated with excellent success rates for insertion and appears easier to use than the Cook Paediatric Intraosseus Insertion needle. Further work to evaluate the use of the intraosseus access device in the prehospital care situation is required.
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Affiliation(s)
- Russell J Boyd
- Department of Emergency Medicine, Lyell McEwin Health Services, Haydown Road, Elizabethvale, SA 5112, Australia.
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Jun H, Haruyama AZ, Chang KS, Yamamoto LG. Comparison of a new screw-tipped intraosseous needle versus a standard bone marrow aspiration needle for infusion. Am J Emerg Med 2000; 18:135-9. [PMID: 10750915 DOI: 10.1016/s0735-6757(00)90003-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study is to compare the speed and ease of establishing intraosseous infusion using a standard bone marrow needle (SBMN; $8) and a new screw-tipped intraosseous needle (Sur-Fast; $42). The study is an experimental design. A total of 42 medical students, without prior IO experience, were recruited as study subjects. Subjects were randomized to perform the IO procedures in one of two models: (1) turkey femur or (2) pork ribs. Each subject performed an initial trial using both IO needles without practice (inexperienced) and a second trial using both IO needles after practice (experienced attempt), such that in total, each subject completed four attempts (two with each needle type). IO placement times were measured, and placement difficulty scores were measured using a 10 cm visual analog scale (VAS). The averaged elapsed time to successful IO completion was significantly shorter for the SBMN in the initial "inexperienced" attempt (33 versus 54 seconds, P = .019), but there was no significant difference in the postpractice "experienced" attempt. VAS difficulty scores were lower (easier) for the SBMN for both inexperienced and experienced trials. Success rates were significantly higher for the Sur-Fast needle during the experienced attempt (95% versus 79%, P < .05), but there was no significant difference in success rates during the inexperienced attempt. The Sur-Fast screw-tipped intraosseous needle does not show superiority over the SBMN in this intraosseous model, therefore its higher cost is difficult to justify based on this study.
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Affiliation(s)
- H Jun
- Department of Pediatrics, University of Hawaii, John A. Burns School of Medicine, Honolulu, USA
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Abe KK, Blum GT, Yamamoto LG. Intraosseous is faster and easier than umbilical venous catheterization in newborn emergency vascular access models. Am J Emerg Med 2000; 18:126-9. [PMID: 10750913 DOI: 10.1016/s0735-6757(00)90001-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study is to compare the speed and ease of establishing newborn emergency vascular access using intraosseous (IO) versus umbilical venous catheterization (UVC). The study is an experimental design. A total of 42 medical students, without prior IO and UVC experience, were recruited as study subjects. All subjects performed the UVC procedure and were randomized (by a coin flip) to perform the IO procedure in one of two models: (1) turkey bone or (2) plastic infant leg. Each subject performed an initial trial for both the IO and UVC procedures without practice ("Inexperienced attempt") and a second trial in both procedures after practice ("Experienced attempt"), such that in total, each subject completed four attempts (two IO and two UVC). IO and UVC placement times were measured, and placement difficulty scores for IO and UVC were measured using a 10 cm visual analog scale (VAS). The averaged elapsed time to successful access was significantly shorter for the IO procedure on both the initial "inexperienced" attempt (52 versus 134 seconds, P < .001) as well as the "experienced" attempt (45 versus 95 seconds, P = .011). Procedure difficulty scores were lower in the IO procedure for both "inexperienced" and "experienced" attempts (3.5 versus 5.5, P = .001 and 2.6 versus 4.7, P < .001) as measured on a 10 cm VAS. Although UVC may be preferred by neonatologists, this model suggests that IO results in easier and more rapid vascular access in those who do not frequently perform newborn resuscitation. As such, the benefit of teaching UVC in pediatric resuscitation courses should be reconsidered. The recommended method of emergency newborn vascular access should be reconsidered pending further studies on this subject.
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MESH Headings
- Animals
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/instrumentation
- Catheterization, Peripheral/methods
- Clinical Competence
- Education, Medical, Undergraduate
- Emergency Treatment/instrumentation
- Emergency Treatment/methods
- Humans
- Infant, Newborn
- Infusions, Intraosseous/adverse effects
- Infusions, Intraosseous/instrumentation
- Infusions, Intraosseous/methods
- Models, Anatomic
- Neonatology/education
- Neonatology/methods
- Resuscitation/education
- Resuscitation/methods
- Tibia
- Time Factors
- Turkeys
- Umbilical Veins
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Affiliation(s)
- K K Abe
- Department of Pediatrics, University of Hawaii, John A. Burns School of Medicine, Honolulu, USA
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