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Intraosseous Blood Correlates with Venous Blood in Healthy Subjects Using Point-of-Care Analyzers

2013; Elsevier BV; Volume: 62; Issue: 4 Linguagem: Inglês

10.1016/j.annemergmed.2013.07.390

1097-6760

Diana Montez, Tatiana Puga, M R Sánchez García, L.J. Miller, Chris Davlantes, Juliette Saussy, Thomas Philbeck,

Mechanical Circulatory Support Devices

Intraosseous (IO) vascular access is useful for fluid and medication delivery and blood sampling when intravenous access is difficult or impossible to obtain. Serum lactate is a potentially useful biomarker when managing patients with severe sepsis or trauma. IO blood values have been shown to correlate with IV blood values for a number of laboratory tests; however, there has been no clinical data indicating the suitability of IO blood for determining serum lactate levels. The objective of this study was to compare IO and venous blood to determine if there is a correlation between samples from the two sources for serum lactate levels. The study protocol was approved by IntegReview IRB and healthy volunteer subjects were consented. From each arm of 15 study subjects, peripheral venous specimens (1.0mL) were collected by phlebotomy, followed by intraosseous specimens drawn from a proximal humerus IO needle (EZ-IO, Vidacare Corp, Shavano Park, TX). A 1.0mL IO blood sample was drawn after discarding the first 1.5 - 2.0 mL of blood drawn from the IO catheter. Each IO and venous sample was analyzed for lactate levels, using the I-Stat point-of-care analyzer. Means and Pearson's correlation were computed to assess the relationship between IO blood lactate levels and venous blood lactate levels. Of 30 specimens from each source, 23 matched pairs of samples were obtained. For 7 sample sets, matched pairs were not obtained due to IO blood clotting prior to injection into the I-Stat sample cartridges. The mean IO blood lactate level was 1.00 ± 0.54 mmol/L; and the mean venous blood lactate level was 1.08 ± 0.50 mmol/L. There was a positive correlation between IO blood lactate and venous blood lactate (R2 = 0.623, n = 23, p <0.001; Figure). Lactate levels obtained from IO blood appear comparable to lactate levels from venous blood, and those values are reflected in positive correlation. While results are promising, the subjects in this study were healthy and results may not accurately reflect the results seen in patients who are septic or have other illnesses and injuries where lactic acidosis is a factor. Further investigation is needed to determine if the relationship between IO and IV values exists in shock patients.