Intraosseous Devices for Intravascular Access in Adult Trauma Patients

Abstract

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.

Comparison of time to obtain intraosseous versus jugular venous catheterization on canine cadavers

“…When IV access is not possible, intraosseous (IO) catheterization is a viable alternative to obtain vascular access. [1][2][3][6][7][8][9][10][11] In fact, due to IV access limitations in small patients, the IO catheter in avian, exotic mammals, and some reptile patients is well utilized. 12 The reason that IO catheterization provides rapid accessible vascular access is due to the rigid nature of bone that prevents bone marrow vessels from collapsing.…”

“…12 The reason that IO catheterization provides rapid accessible vascular access is due to the rigid nature of bone that prevents bone marrow vessels from collapsing. 1,2,5 Administration of drugs and fluids into bone marrow is effective because bone marrow has a well-defined venous system that empties quickly into the systemic circulation. 3 Human medicine now widely accepts IO catheterization when IV access is not obtainable and several IO insertion devices (ie, automated bone injection guns) have been developed to allow for rapid IO catherization.…”

Intraosseous vascular access in critically ill adults—a review of the literature

“…The final 19 research papers were all quantitative or incorporated mixed data collection approaches. Two undertook a retrospective view of IO practices including Sunde et al's (2010) 7-year case notes review and Wampler et al's (2012) retrospective cohort analysis, although they The FAST1 ® is the only device currently approved by the FDA for use on the sternum (PYNG Medical, 2010;Day, 2011). It is designed to be inserted into the manubrium (the upper third of the sternum) and consists of an introducer, which houses several stabilizer points and an infusion tube.…”

“…For many critically ill patients early IV access in emergency situations is vital, and any delays could have a significant impact on the chance of survival (Fenwick, 2010;Hartholt et al, 2010;Schalk et al, 2011). IV has been the conventional route of choice (Gazin et al, 2011) but securing access in the emergency situation can be a challenging process (Ong et al, 2009a;Day, 2011;Schalk et al, 2011). IO provides a reliable alternative (Schalk et al, 2011).…”

The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

“…31 Intraosseous cannulation is another vascular access option that can be emergently placed by nurses. 34,36 Insertion sites include the sternum and the proximal or distal tibia and humerus, and nurses can infuse fluids up to 125 mL/min. The intraosseous catheter should be removed within 24 hours of insertion or as soon as intravenous or central venous access has been achieved.…”