Circumferential pressure as a rapid method to assess intraosseous needle placement

Abstract

This study was done to determine whether the application of circumferential pressure about an intraosseous (IO) site can be used as a rapid method to detect incorrect placement of an IO needle. We used a prospective, randomized, controlled canine tibial IO model. According to random assignment, IO needles were placed either intramedullary (correct placement) or extramedullary (incorrect placement) in the anteromedial tibias of 12 euthanized mongrel dogs. Neonatal blood pressure cuffs were placed contiguously above and below the IO needles. One-liter bags of solution were connected to the IO needles via blood tubing. The gravity-dependent rate of flow at each site was measured with and without the blood pressure cuffs inflated to 120 mmHg. Eleven IO needles were correctly placed and 13 were incorrectly placed. Following inflation of the blood pressure cuffs, the mean percent decrease in flow was 48% for the correctly placed IO needles, and 95% for the incorrectly placed IO needles. A two-way repeated measure of analysis of variance was significant between groups (P = 0.006), and a significant interaction was found between groups and flow rates over time (P = 0.043). We conclude that circumferential pressure about an IO infusion site can be used as a rapid method to detect incorrect placement of the IO needle.