Analysis of intraosseous samples using point of care technology—An experimental study in the anaesthetised pig

Strandberg, Gunnar; Eriksson, Mats; Gustafsson, Mats; Lipcsey, Miklós; Larsson, Anders

doi:10.1016/j.resuscitation.2012.04.007

Cited by 17 publications

(12 citation statements)

References 25 publications

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“…Even if median or mean values of certain parameters seem to be similar for IO and arterial values, it is necessary to compare the differences within individuals, not the mean/median values of whole study populations. Agreement, which is a much more relevant clinical measurement, has been evaluated in a few studies [4, 7, 10, 11, 14, 15]. The results concerning different laboratory parameters vary among these studies.…”

Section: Discussionmentioning

confidence: 99%

Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses

Jousi

Saikko

Nurmi

2017

Scand J Trauma Resusc Emerg Med

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BackgroundPoint-of-care (POC) testing is highly useful when treating critically ill patients. In case of difficult vascular access, the intraosseous (IO) route is commonly used, and blood is aspirated to confirm the correct position of the IO-needle. Thus, IO blood samples could be easily accessed for POC analyses in emergency situations. The aim of this study was to determine whether IO values agree sufficiently with arterial values to be used for clinical decision making.MethodsTwo samples of IO blood were drawn from 31 healthy volunteers and compared with arterial samples. The samples were analysed for sodium, potassium, ionized calcium, glucose, haemoglobin, haematocrit, pH, blood gases, base excess, bicarbonate, and lactate using the i-STAT® POC device. Agreement and reliability were estimated by using the Bland-Altman method and intraclass correlation coefficient calculations.ResultsGood agreement was evident between the IO and arterial samples for pH, glucose, and lactate. Potassium levels were clearly higher in the IO samples than those from arterial blood. Base excess and bicarbonate were slightly higher, and sodium and ionised calcium values were slightly lower, in the IO samples compared with the arterial values. The blood gases in the IO samples were between arterial and venous values. Haemoglobin and haematocrit showed remarkable variation in agreement.DiscussionPOC diagnostics of IO blood can be a useful tool to guide treatment in critical emergency care. Seeking out the reversible causes of cardiac arrest or assessing the severity of shock are examples of situations in which obtaining vascular access and blood samples can be difficult, though information about the electrolytes, acid-base balance, and lactate could guide clinical decision making.The analysis of IO samples should though be limited to situations in which no other option is available, and the results should be interpreted with caution, because there is not yet enough scientific evidence regarding the agreement of IO and arterial results among unstable patients.ConclusionsIO blood samples are suitable for analysis with the i-STAT® point-of-care device in emergency care. The aspirate used to confirm the correct placement of the IO needle can also be used for analysis. The results must be interpreted within a clinical context while taking the magnitude and direction of bias into account.

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Section: Discussionmentioning

confidence: 99%

Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses

Jousi

Saikko

Nurmi

2017

Scand J Trauma Resusc Emerg Med

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“…[20, 21]. We demonstrated previously that analysis of haemoglobin, blood gas and acid base status was feasible using point of care equipment and this was recently repeated in a human study by Veldhoen et al [22, 23]. …”

Section: Discussionmentioning

confidence: 90%

Analysis of thromboelastography, PT, APTT and fibrinogen in intraosseous and venous samples—an experimental study

Strandberg

Lipcsey

Eriksson

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundLaboratory analysis of coagulation is often important in emergencies. If vascular access is challenging, intraosseous catheterization may be necessary for treatment. We studied the analysis of coagulation parameters in intraosseous aspirate during stable conditions and after major haemorrhage in a porcine model.MethodsTen anesthetized pigs received central venous and intraosseous catheters and samples were taken for analysis of thromboelastography (TEG), prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen concentration. Analyses were repeated after removal of 50 % of the calculated blood volume and resuscitation with crystalloid. Intraosseous and venous values were compared.ResultsBleeding and resuscitation resulted in haemodilution and hypotension. Median TEG reaction time was shorter in intraosseous than in venous samples before (1.6 vs 4.6 min) and after (1.6 vs 4.7 min) haemodilution. Median maximal amplitude was smaller in intraosseous samples at baseline (68.3 vs 76.4 mm). No major differences were demonstrated for the other TEG parameters. The intraosseous samples often coagulated in vitro, making analysis of PT, APTT and fibrinogen difficult. After haemodilution, TEG maximal amplitude and α-angle, and fibrinogen concentration, were decreased and PT increased.DiscussionThe intraosseous samples were clinically hypercoagulable and the TEG demonstrated a shortened reaction time. The reason for this may hypothetically be found in the composition of the IO aspirate or in the sampling technique. After 50 % haemorrhage and haemodilution, a clinically relevant decrease in fibrinogen concentration and a lower TEG maximal amplitude were observed.ConclusionsAlthough the sample is small, these data indicate that intraosseous samples are hypercoagulable, which may limit their usefulness for coagulation studies. Major haemodilution only moderately affected the studied parameters.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0318-0) contains supplementary material, which is available to authorized users.

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“…Intraosseous blood can also serve for blood analysis even with I-Stat point-of-care technology [27,28]. There is a repeatedly proofed significant correlation between intravenous and intraosseous infusion samples for hemoglobin, hematocrit and red blood cell counts as well as for glucose, blood urea nitrogen, creatinine, sodium, chloride, total protein and albumin.…”

Section: Complications and General Considerationsmentioning

confidence: 99%

“…There is a repeatedly proofed significant correlation between intravenous and intraosseous infusion samples for hemoglobin, hematocrit and red blood cell counts as well as for glucose, blood urea nitrogen, creatinine, sodium, chloride, total protein and albumin. I-Stat point-of-care analyzers seem to be a convenient and reliable system, bypassing the proposed problem with bone marrow contents threatening to damage conventional laboratory equipment [28]. I-Stat point-of-care analyzers seem to be a convenient and reliable system, bypassing the proposed problem with bone marrow contents threatening to damage conventional laboratory equipment [28].…”

Section: Complications and General Considerationsmentioning

confidence: 99%

Intraosseous infusion in elective and emergency pediatric anesthesia

Neuhaus

2014

Current Opinion in Anaesthesiology

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Most problems in using an intraosseous infusion are provider-dependent. In pediatric anesthesia, the perioperative setting should further contribute to reduce these problems. Nevertheless, regular training, thorough anatomical knowledge and prompt availability especially in the pediatric age group are paramount to get a seldom used technique work properly under pressure. More longitudinal data on large cohorts were preferable to further support the safety of the intraosseous infusion technique in pediatric patients.

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Analysis of intraosseous samples using point of care technology—An experimental study in the anaesthetised pig

Cited by 17 publications

References 25 publications

Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses

Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses

Analysis of thromboelastography, PT, APTT and fibrinogen in intraosseous and venous samples—an experimental study

Intraosseous infusion in elective and emergency pediatric anesthesia

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