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Bone injection gun placement of intraosseous needles
  1. Andrew Curran, Specialist Registrar Emergency Medicine,
  2. Ayan Sen, Clinical Fellow

    Abstract

    A short cut review was carried out to establish whether the Bone Injection Gun is better than a standard intraosseous (IO) needle at obtaining IO access. A total of 129 papers were found using the reported search, of which three represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Andrew Curran, Specialist Registrar Emergency MedicineChecked by Ayan Sen, Clinical Fellow

    Clinical scenario

    A 23 year old shocked patient is brought to into the Emergency Department resuscitation room. The trauma team are trying to gain vascular access. After five minutes of being unable to gain intravenous access you remember a recent training session on a Bone Injection Gun (BIG) and you wonder if this would be better to use than the standard IO needles that you have previously used?

    Three part question

    In [patients requiring IO access] is [the Bone Injection Gun better than standard IO needles] at [safely and rapidly acquiring IO access]?

    Search strategy

    Medline 1966-01/05 using the OVID interface. [exp Infusions, Intraosseous OR intraosseous infusion$.mp OR intraosseous.mp OR IO.mp] AND [BIG.mp OR auto-injector.mp OR auto$.mp OR bone injection gun.mp] LIMIT to English

    Search outcome

    Altogether 129 papers were found, of which three were relevant to the three part question.

    Comment(s)

    There are no published studies looking at the use of the BIG in live adults or children. Though this would be ideal it is unlikely to be achievable as IO placement is a rare event and there would be ethical and consent issues. We must therefore extrapolate data from other models. The paper by Calkins et al shows that the technique itself is easy to learn by non-medical trained responders, this may have implications for its use in prehospital care. This paper also used the screw tipped IO needle as the standard needle but in practice people may be more used to the standard straight needle. Waismann and Waismann suggest that they can be used succesfully in practice. Olsen found a higher failure rate in anaesthetised dogs but explained this was due to poor landmark identification rather than device failure. The differences in time to placement are unlikely to be clinically significant. From a clinical perspective there appears to be little to choose between them and issues such as cost and training may influence local decisions.

    CLINICAL BOTTOM LINE

    The Bone Injection Gun appears to be equivalent in terms of success and possibly (but not clinically significantly) faster to use than standard IO needles at achieving IO access.

    Table 2

    Report by Andrew Curran, Specialist Registrar Emergency MedicineChecked by Ayan Sen, Clinical Fellow

    References

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