Ultrasound to Improve Target Site Identification for Proximal Humerus Intraosseous Vascular Access

Bustamante, Sergio; Cheruku, Shravan

doi:10.1213/ane.0000000000001543

Cited by 6 publications

(3 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the case of a difficult palpable anatomy, the use of ultrasound could be beneficial in the proximal tibia, as some authors suggest for the purpose of identifying the structures in the humerus. 20 …”

Section: Discussionmentioning

confidence: 99%

Sex differences in appropriate insertion depth for intraosseous access in adults: An exploratory radiologic single-center study

Miller¹,

Nardelli

Hell

et al. 2022

J Vasc Access

View full text Add to dashboard Cite

Background: Intraosseous access is a recommended alternative to venous access in emergencies. For its application, knowledge of the correct insertion depth is indispensable. We aimed to determine sex-specific differences on the appropriate insertion depth for intraosseous access in adults at the insertion sites most frequently used, namely the proximal and distal tibia and the proximal humerus. Methods: In this exploratory retrospective study, we measured thickness of soft tissue cover, cortex and cancellous bone along the puncture line on magnetic resonance images or computed tomography scans. Inclusion criteria were both sexes, 18–90 years of age and appropriate image quality. Primary outcome was the appropriate insertion depth to reach the cancellous bone for each sex. This was defined as the corridor between (i) the sum of the soft tissue cover and the cortex and (ii) the sum of (i) plus the diameter of the cancellous bone. Secondary outcomes were the differences in thickness of each layer between sexes. Results: In 179 females and males, the appropriate insertion depth was 32.5–45.5 mm and 20.5–42.0 mm in the proximal tibia, 14.5–30.5 mm and 16.5–34.5 mm in the distal tibia, and 27.5–52.5 mm and 26.0–56.5 mm in the proximal humerus. Although females had a thicker soft tissue cover (+6.8 mm [95% CI 3.7–10.1], p < 0.01) in the proximal tibia, extrapolation by correlation analysis showed no clinically relevant difference between the sexes. Conclusion: In adults, there are no sex-specific differences in the appropriate insertion depth for intraosseous access in the proximal or distal tibia or in the proximal humerus.

show abstract

Section: Discussionmentioning

confidence: 99%

Sex differences in appropriate insertion depth for intraosseous access in adults: An exploratory radiologic single-center study

Miller¹,

Nardelli

Hell

et al. 2022

J Vasc Access

View full text Add to dashboard Cite

show abstract

“…However, studies have shown that it had a lower success rate compared to the proximal tibia when landmarks were identified by palpation 4–6 . Incorrect identification or an inability to palpate landmarks could be due to prominent deltoid musculature or overlying adipose tissue 7 . Additionally, the inability to identify the anatomic landmarks of the PH is an absolute contraindication for IO access 8…”

mentioning

confidence: 99%

“…We previously demonstrated that ultrasound (US) can be used to identify the landmarks of the PH in human cadavers 7 . However, it is not known whether the same landmarks can be reliably identified in live human patients with a varying body habitus.…”

mentioning

confidence: 99%

Point‐of‐Care Ultrasound to Identify Landmarks of the Proximal Humerus

Bustamante

Bajracharya

Cheruku

et al. 2020

J of Ultrasound Medicine

Self Cite

View full text Add to dashboard Cite

Objectives The inability to identify landmarks is an absolute contraindication for intraosseous access. The feasibility of landmark identification using ultrasound (US) has been demonstrated on human cadavers. We aimed to study the feasibility of point‐of‐care US in identifying proximal humerus landmarks in living human patients. Methods This was a prospective cohort study conducted from May 3 to June 7, 2017, after approval from the Institutional Review Board at the Cleveland Clinic. Sixty upper extremities of 30 consenting participants across 3 distinct body mass index (BMI) groups (normal, obese, and morbidly obese) were alternately examined with a 12 L‐RS linear US transducer (GE Healthcare, Chicago, IL) by 2 investigators. Six anatomic landmarks were identified: the humeral shaft, the surgical neck of the humerus, the lesser tubercle, the greater tubercle, the inter tubercular sulcus, and the target site for needle insertion on the greater tubercle. Rates of successful identification of all 6 landmarks as defined by independent agreement between the investigators were reported as estimated incidence rates with 95% bootstrap confidence interval (CI) sampling at the participant level. Results Ultrasound had an overall success rate of 0.87 (95% CI, 0.78–0.95) in identifying all 6 landmarks with slight variability among various BMI groups. After excluding the surgical neck, the overall success rate improved to 0.93 (95% CI, 0.87–0.98), with minimum variability across BMI groups and no change in the ability to identify the target site. Conclusions Ultrasound is reliable in identifying proximal humerus intraosseous landmarks, with reasonable accuracy across various BMI groups.

show abstract

Intraosseous Catheters

Kenney¹,

Paxton²

2021

Emergent Vascular Access

View full text Add to dashboard Cite

Ultrasound to Improve Target Site Identification for Proximal Humerus Intraosseous Vascular Access

Cited by 6 publications

References 4 publications

Sex differences in appropriate insertion depth for intraosseous access in adults: An exploratory radiologic single-center study

Sex differences in appropriate insertion depth for intraosseous access in adults: An exploratory radiologic single-center study

Point‐of‐Care Ultrasound to Identify Landmarks of the Proximal Humerus

Intraosseous Catheters

Contact Info

Product

Resources

About