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Performance of a novel, manually operated intraosseous device in adult human cadavers

Sandeep Singh, MD, DM, Balram Bhargava, MD, DM, Praveen Aggarwal, MD, Renu Dhingra, MSc, PhD, Arun Kumar Gupta, MD, Rakesh Lodha, MD, Ramesh Agarwal, MD, Jayant S. Karve, BTech, MDes

Abstract


Aim: Intraosseous (IO) access in adults is preferred using semi-automatic devices as it is difficult to penetrate the thick cortical layer of long bones using manual needles. The authors have developed an IO device which generates both rotational and axial thrust using a manual driver. This drilling mechanism addresses certain pain-points of current IO devices. The objective of this study was to evaluate the performance of this device in human cadavers.

Methods: The authors tested the ability of this device for IO access at proximal and distal tibia in 10 adult cadavers. Needle position was confirmed by fluoroscopy after contrast injection. Needle penetration time—defined as the time required for manual drilling of bone—and the total procedure time were calculated from video analysis. A successful IO procedure was defined as an appropriate needle position without any contrast extravasation, device, or procedure-related complication. After each procedure, the authors recorded damage to the device or fracture of the bone.

Results: A single physician performed 40 IO procedures. The IO access was successful in 35 (87.5 percent) and was accomplished in first attempt in 33 (82.5 percent) insertions. Reasons for failure were undershooting of needle (2/40, 5 percent), trocar damage (1/40, 2.5 percent), and detachment of plastic hub of the needle during removal in (2/40, 5 percent) procedures. There were no bone fractures. In all but one instance, needle penetration time was <3 seconds. The mean total procedure time was 40 ± 13 seconds.

Conclusion: In this pilot study, the authors have demonstrated the efficacy of a novel, manually introduced IO device in adult cadavers.


Keywords


difficult intravenous access, failed intravenous access, intraosseous device, intraosseous needle, emergency vascular access

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References


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DOI: http://dx.doi.org/10.5055/ajdm.2018.0283

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