Evaluation of an Intraosseous Infusion Device for the Resuscitation of Hypovolemic Shock

Halvorsen, L.; Bay, Brian K.; Perron, P. R.; Gunther, Robert A.; Holcroft, James W.; Blaisdell, F. William; Kramer, George C.

doi:10.1097/00005373-198907000-00038

Cited by 14 publications

(7 citation statements)

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“…Most IO cannulas for adults are 15-gauge needles, and enable flow rates comparable to a 20-gauge peripheral IV catheter. IO Flow rates on gravidity account between 10-34 ml/min and can be increased up to 80-165 ml/min using a pressure bag [ 25 , 42 - 45 ]. Therefore IO rapid volume resuscitation is limited, however two or more IO cannulations in the same patient may facilitate fluid therapy [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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

Leidel

Kirchhoff²,

Bogner³

et al. 2009

Patient Saf Surg

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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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Section: Discussionmentioning

confidence: 99%

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

Leidel

Kirchhoff²,

Bogner³

et al. 2009

Patient Saf Surg

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“…Even if intravenous access was established, the small lumen of the catheters inhibited the rapid flow of intravenous fluid, medications, and blood. Multiple reviews, 7,10,11 reports, and studies in the 1980s and early 1990s indicated the effectiveness of intraosseous devices in animal models, [12][13][14] in children and adults in the prehospital setting, 15,16 and in adults in the hospital. 6 On the basis of these studies, in 1985 the American Heart Association 17 endorsed the use of intraosseous devices in children; the current guidelines 18 continue that endorsement.…”

Section: Intraosseous Anatomymentioning

confidence: 99%

Intraosseous Devices for Intravascular Access in Adult Trauma Patients

Day

2011

Critical Care Nurse

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Three intraosseous devices have been approved by the Food and Drug Administration for use in adult trauma patients when intravenous access cannot be obtained. Sites of insertion are the sternum (FAST1), proximal tibia and humerus (Big Injection Gun), and proximal and distal tibia and humerus (EZ-IO). Insertion generally requires less than 1 minute, and flow rates up to 125 mL/min can be achieved. The devices are used for emergency resuscitation and should be removed within 24 hours of insertion or as soon as practical after peripheral or central intravenous access has been achieved. Contraindications include fractures or other trauma at the insertion site, prosthetic joints near the site, previous attempts to insert an intra osseous device at the same site, osteoporosis or other bone abnormalities, infections at the proposed site, and inability to identify pertinent insertion landmarks. Primary complications are extravasation of medications and fluids into the soft tissue, fractures caused by the insertion, and osteomyelitis.

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“…Comparisons between IO access and IV access, via saphenous vein cut down, indicate that success rates are higher for the IO route (92% vs. 69%) and time to initiate flow is shorter (3.9 vs. 7.6 minutes). 26 The results of these studies justified a subsequent field trial of this IO system, 23 and the data were identified by the Federal Drug Administration as a major factor in expediting its full approval of the FAST 1.…”

Section: Insertion Protocolmentioning

confidence: 84%

“…18,22 However, in military 15 and civilian circles, this stance is changing. 16,23 There is a need for a faster and more reliable method of vascular access in the prehospital environment, and IO was identified as a promising option. A research and development project was performed to develop a new, sternal IO device that included cadaver research on human sternal anatomy, an iterative prototype development process that focused on ergonomics, and extensive bench testing.…”

mentioning

confidence: 99%

Paramedic Evaluation of Adult Intraosseous Infusion System

Findlay¹,

Johnson²,

Macnab

et al. 2006

Prehosp. Disaster med.

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Introduction:The First Access for Shock and Trauma (FAST 1) Sternal Intraosseous (IO) System is a vascular access device designed as an alternative to peripheral or central intravenous (IV) cannulation for the treatment of critically ill and injured adults. During the development of the device, key objectives included safety, speed of insertion, and ease of use with minimal training. This study evaluated these characteristics.Methods:Ten experienced paramedics participated in a 90-minute training program for the use of the FAST 1 System at the Paramedic Academy of the Justice Institute of British Columbia. Then, the paramedics used thesystem in three simulated prehospital scenarios and evaluated the ease of use and compatibility of the training method with current practice using a 10-centimeter (cm) (3.94 inches (in)), visual analog scale.Results:The duration of the procedure from opening the package to initiation of fluid flow ranged 52–127 seconds (mean = 92 ±32 seconds). Placement accuracy was excellent, with a mean displacement of 2 mm (0.08 in) and 1 mm (0.04 in) in the vertical and horizontal planes, respectively. The paramedics rated the system highly in all areas. They considered the training “straight forward” and “comprehensive”. The possibility for interference between the IO system and cervical collars was reported, and several suggestions to remedy this and achieve other improvements were made.Conclusions:Placement of the FAST 1 is fast, accurate, and easy to use. Paramedics had useful input concerning the design of the product.

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Evaluation of an Intraosseous Infusion Device for the Resuscitation of Hypovolemic Shock

Cited by 14 publications

References 0 publications

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

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

Intraosseous Devices for Intravascular Access in Adult Trauma Patients

Paramedic Evaluation of Adult Intraosseous Infusion System

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