Portal de Periódicos da CAPES

135 Sternal Flow Rates and Insertion Success Using a Multisite Intraosseous Device

2015; Elsevier BV; Volume: 66; Issue: 4 Linguagem: Inglês

10.1016/j.annemergmed.2015.07.167

1097-6760

Thomas Philbeck, Tatiana Puga, Diana Montez, L.J. Miller, Juliette Saussy, Chris Davlantes,

Trauma and Emergency Care Studies

Study ObjectivesThe intraosseous (IO) vascular access route is an effective option for vascular delivery of critically needed drugs and fluids. Flow rates are site and device size dependent with a wide range of reported infusion flow rates through the proximal humerus and tibia using a 15 g needle set. First described by Tocantins in 1940, the sternum was among the first bones used for IO access. This site option is important when other sites are contraindicated, as with injuries sustained due to explosives when the manubrium may be the most accessible uninjured site; yet there is a paucity of published data describing infusion flow rates and other performance characteristics through this bone. In 2012, an FDA-cleared manually inserted multi-site (sternum, humerus and tibia) IO device was introduced (Arrow EZ-IO T.A.L.O.N, Teleflex Inc., Reading, PA) primarily for military and tactical medicine use. A prospective, single site study of the T.A.L.O.N. device was conducted to examine performance characteristics, including flow rates; using healthy volunteers as study subjects.MethodsIRB approval was obtained and subjects were recruited. Prior to insertion into subjects, device training was conducted with mannequins and cadavers. The device consists of a 38.5 mm, 15 g needle set used with a sternal locator to establish IO access in the sternum, and without locator for extremity access. Twenty four sternal IO insertions were performed by 8 certified military trained medics. To simulate a field scenario and assess needle retention during movement, insertions were made on a litter positioned on the floor. Subjects were then lifted and transferred to an examination table. For infusion pain 2% preservative and epinephrine-free lidocaine was given; then contrast was injected for visualization by fluoroscopy to verify placement and rule out extravasation. Normal saline (NS) was infused using a pressure bag with flow rates calculated after 3 minutes of infusion with gravity and infusion pressures of 100 mm Hg, 200 mm Hg, and 300 mm Hg. The NS bag was weighed before and after each infusion to determine volume infused. Subjects were monitored for signs of extravasation during infusion. A second contrast bolus was given after the last infusion pressure tested to determine if extravasation occurred during the pressure infusion.ResultsSubject mean age was 33.4 ± 8.8 years; 79% were male. Subject mean body mass index (BMI) was 26.3 (range: 17.1-31.7). Four subjects (17%) had a BMI greater than 30, but had palpable landmarks and did not have excessive tissue overlying the insertion site. Successful needle placement was initially confirmed by aspiration in 100% of cases. After the subjects were moved, one case of minor extravasation (noted after the 100 mm Hg infusion) and one case of needle dislodgment were observed under fluoroscopy, yielding a first attempt placement success rate with functionality of 92%. In no cases was there penetration of the posterior cortex of the manubrium. The mean infusion rates were gravity: 1130 ±. 692 mL/hr (n=23), 100 mm Hg: 3374 ± 1370 mL/hr (n=23), 200 mm Hg: 4619 ± 1785 mL/hr (n=21) and 300 mm Hg: 5327 ± 1724 mL/hr (n=22).There were no serious complications.ConclusionResults suggest that the T.A.L.O.N. may be used by military and tactical medicine personnel to safely and successfully establish IO vascular access in the sternum with excellent infusion flow rates. Study ObjectivesThe intraosseous (IO) vascular access route is an effective option for vascular delivery of critically needed drugs and fluids. Flow rates are site and device size dependent with a wide range of reported infusion flow rates through the proximal humerus and tibia using a 15 g needle set. First described by Tocantins in 1940, the sternum was among the first bones used for IO access. This site option is important when other sites are contraindicated, as with injuries sustained due to explosives when the manubrium may be the most accessible uninjured site; yet there is a paucity of published data describing infusion flow rates and other performance characteristics through this bone. In 2012, an FDA-cleared manually inserted multi-site (sternum, humerus and tibia) IO device was introduced (Arrow EZ-IO T.A.L.O.N, Teleflex Inc., Reading, PA) primarily for military and tactical medicine use. A prospective, single site study of the T.A.L.O.N. device was conducted to examine performance characteristics, including flow rates; using healthy volunteers as study subjects. The intraosseous (IO) vascular access route is an effective option for vascular delivery of critically needed drugs and fluids. Flow rates are site and device size dependent with a wide range of reported infusion flow rates through the proximal humerus and tibia using a 15 g needle set. First described by Tocantins in 1940, the sternum was among the first bones used for IO access. This site option is important when other sites are contraindicated, as with injuries sustained due to explosives when the manubrium may be the most accessible uninjured site; yet there is a paucity of published data describing infusion flow rates and other performance characteristics through this bone. In 2012, an FDA-cleared manually inserted multi-site (sternum, humerus and tibia) IO device was introduced (Arrow EZ-IO T.A.L.O.N, Teleflex Inc., Reading, PA) primarily for military and tactical medicine use. A prospective, single site study of the T.A.L.O.N. device was conducted to examine performance characteristics, including flow rates; using healthy volunteers as study subjects. MethodsIRB approval was obtained and subjects were recruited. Prior to insertion into subjects, device training was conducted with mannequins and cadavers. The device consists of a 38.5 mm, 15 g needle set used with a sternal locator to establish IO access in the sternum, and without locator for extremity access. Twenty four sternal IO insertions were performed by 8 certified military trained medics. To simulate a field scenario and assess needle retention during movement, insertions were made on a litter positioned on the floor. Subjects were then lifted and transferred to an examination table. For infusion pain 2% preservative and epinephrine-free lidocaine was given; then contrast was injected for visualization by fluoroscopy to verify placement and rule out extravasation. Normal saline (NS) was infused using a pressure bag with flow rates calculated after 3 minutes of infusion with gravity and infusion pressures of 100 mm Hg, 200 mm Hg, and 300 mm Hg. The NS bag was weighed before and after each infusion to determine volume infused. Subjects were monitored for signs of extravasation during infusion. A second contrast bolus was given after the last infusion pressure tested to determine if extravasation occurred during the pressure infusion. IRB approval was obtained and subjects were recruited. Prior to insertion into subjects, device training was conducted with mannequins and cadavers. The device consists of a 38.5 mm, 15 g needle set used with a sternal locator to establish IO access in the sternum, and without locator for extremity access. Twenty four sternal IO insertions were performed by 8 certified military trained medics. To simulate a field scenario and assess needle retention during movement, insertions were made on a litter positioned on the floor. Subjects were then lifted and transferred to an examination table. For infusion pain 2% preservative and epinephrine-free lidocaine was given; then contrast was injected for visualization by fluoroscopy to verify placement and rule out extravasation. Normal saline (NS) was infused using a pressure bag with flow rates calculated after 3 minutes of infusion with gravity and infusion pressures of 100 mm Hg, 200 mm Hg, and 300 mm Hg. The NS bag was weighed before and after each infusion to determine volume infused. Subjects were monitored for signs of extravasation during infusion. A second contrast bolus was given after the last infusion pressure tested to determine if extravasation occurred during the pressure infusion. ResultsSubject mean age was 33.4 ± 8.8 years; 79% were male. Subject mean body mass index (BMI) was 26.3 (range: 17.1-31.7). Four subjects (17%) had a BMI greater than 30, but had palpable landmarks and did not have excessive tissue overlying the insertion site. Successful needle placement was initially confirmed by aspiration in 100% of cases. After the subjects were moved, one case of minor extravasation (noted after the 100 mm Hg infusion) and one case of needle dislodgment were observed under fluoroscopy, yielding a first attempt placement success rate with functionality of 92%. In no cases was there penetration of the posterior cortex of the manubrium. The mean infusion rates were gravity: 1130 ±. 692 mL/hr (n=23), 100 mm Hg: 3374 ± 1370 mL/hr (n=23), 200 mm Hg: 4619 ± 1785 mL/hr (n=21) and 300 mm Hg: 5327 ± 1724 mL/hr (n=22).There were no serious complications. Subject mean age was 33.4 ± 8.8 years; 79% were male. Subject mean body mass index (BMI) was 26.3 (range: 17.1-31.7). Four subjects (17%) had a BMI greater than 30, but had palpable landmarks and did not have excessive tissue overlying the insertion site. Successful needle placement was initially confirmed by aspiration in 100% of cases. After the subjects were moved, one case of minor extravasation (noted after the 100 mm Hg infusion) and one case of needle dislodgment were observed under fluoroscopy, yielding a first attempt placement success rate with functionality of 92%. In no cases was there penetration of the posterior cortex of the manubrium. The mean infusion rates were gravity: 1130 ±. 692 mL/hr (n=23), 100 mm Hg: 3374 ± 1370 mL/hr (n=23), 200 mm Hg: 4619 ± 1785 mL/hr (n=21) and 300 mm Hg: 5327 ± 1724 mL/hr (n=22).There were no serious complications. ConclusionResults suggest that the T.A.L.O.N. may be used by military and tactical medicine personnel to safely and successfully establish IO vascular access in the sternum with excellent infusion flow rates. Results suggest that the T.A.L.O.N. may be used by military and tactical medicine personnel to safely and successfully establish IO vascular access in the sternum with excellent infusion flow rates.