Intraosseous Catheter Flow Rates and Ease of Placement at Various Sites in Canine Cadavers

Abstract

Objective: To compare intraosseous catheter placement difficulty, success rates, and flow rates at four different locations in canine cadavers.Design: Prospective study.Setting: Private referral center.Animals: Eleven fresh canine cadavers.Interventions: With owner consent, animals presenting for euthanasia were recruited. Animals received heparin (1,000 IU/kg IV) at least 5 min prior to euthanasia. After euthanasia, EZIO intraosseous catheters were placed into the ilial wing, proximal medial tibia, proximal lateral humerus, and distal lateral femur on one side of the animal. Time to catheter placement and catheter difficulty were scored for each placement site. Sterile saline was infused into each location simultaneously over 5 min, first via gravity then using 300 mmHg pressure. Animals were repositioned onto the contra-lateral side and the experiment repeated.Measurements and Main Results: Placement was successful in 16/22 ilial, 18/22 tibial, and 22/22 femoral and humoral attempts. A post-hoc analysis revealed the ileum had a significantly greater difficulty score when compared to the femur and humerus (p ≤ 0.0001). The femur had a statistically significant faster placement time when compared to the ileum (p ≤ 0.05). Gravity infusion rates were statistically lower in the tibia when compared to humerus (p ≤ 0.01) and between the tibia when compared to the femur (p ≤0.001). Additionally, pressurized infusion rates were statistically lower in the tibia compared to the humerus (p ≤ 0.0001), the femur (p ≤ 0.0001), and the ileum (p ≤ 0.01).Conclusions: The femur and humerus had high success rate for IO catheter placement and low placement time and difficulty scores. Pressurized intraosseous flow rates were highest in the humerus and femur. Contrary to human literature, success rates for catheter placement in the humerus and femur were higher than at other sites, suggesting the humerus and femur may be preferred sites for intraosseous catheter placement in the dog. Further investigation through a larger sample size is required to confirm these findings.

Finding alternative sites for intraosseous infusions in newborns

“…muscle and fascia) during pressured infusion (up to 300mmH 2 0) seems not unlikely, as shown in experimental animal studies. 19,27,28 This would explain the initial successful IO infusion followed by the subsequent dislocation of the needle. With regard to a suitable and secure emergency IO access, further anatomical studies are needed to determine the accuracy and safety of new alternative puncture areas as described in our study.…”

Terms, Definitions, Nomenclature, and Routes of Fluid Administration

“…Despite increased resistance to flow compared to intravenous infusion, reasonably high fluid administration rates can still be achieved with intramedullary delivery ( 158 ). The gravity-dependent rate of fluid delivery was greater in the femur and humerus compared to the tibia and ilium in one canine cadaveric study ( 159 ).…”

Advanced Vascular Access in Small Animal Emergency and Critical Care

“…Limitations of placement include need for specialized equipment (except in case of using a hypodermic needle), which may restrict availability. Flow rate is also limited by needle diameter and the bone selected ( 58 ). Contraindications include osteomyelitis, regional pyoderma, preexisting fracture, and orthopedic hardware in the location of interest ( 53 , 54 ).…”

“…In dogs, successful placement has been described in the proximal humerus, lateral humeral condyle, trochanteric fossa, wing of the ilium, and medial proximal tibia ( 27 , 54 , 58 ). A canine cadaveric study found the proximal humerus and distal femur to have the best combination of high flow rates and ease of access ( 58 ). IO access has also been investigated in cats at the medial tibia and proximal humerus ( 56 ).…”