Maximising intraosseous flow rates: an in-vitro study
Abstract
Background:
Attaching a different or using no extension set with intraosseous (IO) needles may affect the time taken to administer fluid. An in-vitro study measured this effect.
Methodology:
Three methods of administration were examined (10 experiments for each approach): a fluid-giving set directly placed in the IO needle hub (direct-to-hub: DTH); a fluid-giving set connected to the EZ-IO device extension set (EZ set: EZS); and a fluid-giving set connected to a simple three-way extension set (three-way set: TWS).
Results:
Mean times for administration were 317 s for DTH (SD=15 s), 322 s for TWS (SD=8 s) and 361 s for EZS (SD=19 s). This demonstrated a significant difference between the three groups (ANOVA significance
Conclusion:
It may be possible for clinicians to increase IO flow rates by removing or replacing the extension set that is supplied with the EZ-IO needle set.
Timely acquisition of reliable vascular access is essential for the delivery of both drugs and fluids for critically unwell patients (Lewis and Wright, 2015). In practice, however, this is frequently difficult as peripheral veins can collapse during hypovolaemia and haemorrhage (Anson, 2014). Additionally, the degree of urgency in which vascular access is required is often directly proportional to the difficulty of the insertion (Lewis and Wright, 2015).
Intraosseous (IO) access uses the rich, non-collapsible vascular system within the bone marrow cavity to overcome many of the problems faced by clinicians (Rosenberg and Cheung, 2013). The success of this approach has led to its widespread adoption within many guidelines as a standard approach when traditional peripheral intravenous (IV) access is difficult or impossible (Maconochie et al, 2015; Nolan et al, 2016).
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