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Intraosseous infusion rates under high pressure

A cadaveric comparison of anatomic sites

Pasley, Jason DO; Miller, Catriona H.T. PhD; DuBose, Joseph J. MD; Shackelford, Stacy A. MD; Fang, Raymond MD; Boswell, Kimberly MD; Halcome, Chuck; Casey, Jonathan MSN; Cotter, Michael; Matsuura, Michael MD; Relph, Nathaniel; Tarmey, Nicholas T. MBChB; Stein, Deborah M. MD, MPH

Journal of Trauma and Acute Care Surgery: February 2015 - Volume 78 - Issue 2 - p 295–299
doi: 10.1097/TA.0000000000000516
EAST 2013 Plenary Papers

BACKGROUND When traditional vascular access methods fail, emergency access through the intraosseous (IO) route can be lifesaving. Fluids, medications, and blood components have all been delivered through these devices. We sought to compare the performance of IO devices placed in the sternum, humeral head, and proximal tibia using a fresh human cadaver model.

METHODS Commercially available IO infusion devices were placed into fresh human cadavers: sternum (FAST-1), humeral head (EZ-IO), and proximal tibia (EZ-IO). Sequentially, the volume of 0.9% saline infused into each site under 300 mm Hg pressure over 5 minutes was measured. Rates of successful initial IO device placement and subjective observations related to the devices were also recorded.

RESULTS For 16 cadavers over a 5-minute bolus infusion, the total volume of fluid infused at the three IO access sites was 469 (190) mL for the sternum, 286 (218) mL for the humerus, and 154 (94) mL for the tibia. Thus, the mean (SD) flow rate infused at each site was as follows: (1) sternum, 93.7 (37.9) mL/min; (2) humerus, 57.1 (43.5) mL/min; and (3) tibia, 30.7 (18.7) mL/min. The tibial site had the greatest number of insertion difficulties.

CONCLUSION This is the first study comparing the rate of flow at the three most clinically used adult IO infusion sites in an adult human cadaver model. Our results showed that the sternal site for IO access provided the most consistent and highest flow rate compared with the humeral and tibial insertion sites. The average flow rate in the sternum was 1.6 times greater than in the humerus and 3.1 times greater than in the tibia.

From the R Adams Cowley Shock Trauma Center (J.P., C.H.T.M., S.A.S., R.F., K.B., C.H., J.C., M.C., M.M., N.R., D.M.S.), University of Maryland Medical Center; and US Air Force Center for Sustainment of Trauma and Readiness Skills (J.P., C.H.T.M., S.A.S., R.F., C.H., J.C., M.C., M.M., N.R.), Baltimore, Maryland; Texas Trauma Institute University of Texas at Houston (J.J.D.), Houston, Texas; and Department of Critical Care (N.T.T.), Ministry of Defence Hospital Unit, Portsmouth, United Kingdom.

Submitted: December 1, 2013, Revised: March 18, 2014, Accepted: October 23, 2014.

This study was presented at the 27th annual meeting of the Eastern Association for the Surgery of Trauma, January 14–18, 2014, in Naples, Florida.

The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of the US Air Force 711 HPW/XPT, the US Air Force, or the US Government.

The US Government is authorized to reproduce and distribute reprints for governmental purposes notwithstanding any copyright notation thereon.

Address for reprints: Jason Pasley, DO, US Air Force Center for Sustainment of Trauma and Readiness Skills, 22 South Greene St, T4M14 Baltimore, MD 21201; email:

© 2015 Lippincott Williams & Wilkins, Inc.