Comparison of a new screw-tipped intraosseous needle versus a standard bone marrow aspiration needle for infusion

doi:10.1016/S0735-6757(00)90003-2

The American Journal of Emergency Medicine

Volume 18, Issue 2, March 2000, Pages 135-139

https://doi.org/10.1016/S0735-6757(00)90003-2 Get rights and content

Abstract

The purpose of this study is to compare the speed and ease of establishing intraosseous infusion using a standard bone marrow needle (SBMN; $8) and a new screw-tipped intraosseous needle (Sur-Fast; $42). The study is an experimental design. A total of 42 medical students, without prior IO experience, were recruited as study subjects. Subjects were randomized to perform the IO procedures in one of two models: (1) turkey femur or (2) pork ribs. Each subject performed an initial trial using both IO needles without practice (inexperienced) and a second trial using both IO needles after practice (experienced attempt), such that in total, each subject completed four attempts (two with each needle type). IO placement times were measured, and placement difficulty scores were measured using a 10 cm visual analog scale (VAS). The averaged elapsed time to successful IO completion was significantly shorter for the SBMN in the initial “inexperienced” attempt (33 versus 54 seconds, P = .019), but there was no significant difference in the postpractice “experienced” attempt. VAS difficulty scores were lower (easier) for the SBMN for both inexperienced and experienced trials. Success rates were significantly higher for the Sur-Fast needle during the experienced attempt (95% versus 79%, P < .05), but there was no significant difference in success rates during the inexperienced attempt. The Sur-Fast screw-tipped intraosseous needle does not show superiority over the SBMN in this intraosseous model, therefore its higher cost is difficult to justify based on this study.

References (11)

PW Glaeser et al.
Emergency intraosseous infusions in children
Am J Emerg Med
(1986)
PW Glaeser et al.
Five-year experience in prehospital intraosseous infusions in children and adults
Ann Emerg Med
(1993)
RM McNamara et al.
Pediatric resuscitation without an intravenous line
Am J Emerg Med
(1986)
B Halm et al.
Comparing ease of intraosseous needle placement: Jamshidi versus Cook
Am J Emerg Med
(1998)
KK Abe et al.
Intraosseous is faster and easier than umbilical venous catheterization in newborn emergency vascular access models
Am J Emerg Med
(2000)

There are more references available in the full text version of this article.

Cited by (29)

EZ-IO in the ED: An observational, prospective study comparing flow rates with proximal and distal tibia intraosseous access in adults
2012, American Journal of Emergency Medicine
Citation Excerpt :
This allows the medullary cavity to be used for the purpose of infusions in emergency situation. The standard IO needle has been compared with newer designed needles and most recently IO access devices [2-8]. Numerous insertion sites have been documented, the most common being the proximal tibia in view of its reliable and prominent landmarks and its relatively thin cortex.
Intraosseous (IO) access is an important alternative to conventional intravenous access when intravenous access is difficult.
A nonrandomized, prospective, observational study comparing flow rates with distal and proximal tibia IO access in adults using the EZ-IO–powered drill device. The proximal tibia was the first site of insertion, and a second IO was inserted in the distal tibia if clinically indicated. Intravenous saline infusion was started for all patients, initially without, then with a pressure bag device applied.
From September 19, 2008 to November 3, 2010, 22 patients were recruited, with 20 proximal tibial and 22 distal tibia insertions. Two patients had only distal tibia IO insertions. Five distal tibia and 3 proximal tibia insertions had no flow when initiating normal saline infusion without pressure. Upon comparing the mean flow rates without pressure bag, it is significantly faster in the proximal tibia, 4.96 mL/min, compared with distal tibia, 2.07 ml/min, difference of 2.89 ml/min (95% CI 1.20-4.58). Flow rates with pressure bags also revealed a similar result. Flow rates in the proximal tibia were significantly faster, 7.70 ml/min to that of distal tibia, 3.80 ml/min, difference of 3.89 ml/min (95% CI 1.68-6.10). In both proximal and distal tibia groups, the flow rates are also significantly faster with pressure bags compared with without.
Flow rates are significantly faster in the proximal tibia compared with the distal tibia. In addition, flow rates with pressure bags are significantly faster than without pressure bags in both groups.
Current advances in intraosseous infusion - A systematic review
2012, Resuscitation
Citation Excerpt :
The Jamshidi/Illinois (Cardinal Health, McGaw Park, IL), the threaded Sur-Fast needle, and the Dieckman modified needle (both from Cook Critical Care, Bloomington, IN) are the most commonly used manual IO needles. These needles are all relatively similar, and their success rate, time for insertion, and ease-of-use seem to be comparable.20–22 Previous studies and case reports showed that manual needles can be easily used in young paediatric patients, but are considered technically more difficult in older patients.23,24
To describe the advancement of Intraosseous (IO) infusion in the spectrum of resuscitative protocols and to provide a systematic review on currently used semi-automatic IO infusion devices. The specific question addressed was: “In patients undergoing resuscitation, does the use of semi-automatic IO infusion devices compared to manual needles influence IO placement success rate, time for IO placement, and ease-of-use and user preference?”
The electronic databases PubMed and Embase were searched for articles published from 1997 to 2010 using the search terms (“intraosseous”) AND (“needle” or “device” or “technique”) AND (“infusion” or “injection” or “access”). The Internet search engine Google Scholar was searched using the search term “intraosseous infusion device” to identify articles published in electronic journals, books, and scientific websites. Articles were included only if they compared at least two types of semi-automatic devices, or compared one or more semi-automatic device with one or more manual needles. Reviews, editorials, surveys, and case reports were excluded.
The search strategy yielded 179 papers. Ten studies met full criteria for further review. Of these, two were LOE 1 (randomized controlled trials), one was LOE 2 (non-randomized, concurrent controls), one was LOE 3 (retrospective controls), and six were LOE 5 (simulation-based study). One of the six LOE 5 studies was a non-peer reviewed article.
Only a few studies compared the performance of different types of IO infusion devices, most of them have a low level of evidence. These studies suggested a superiority of the battery-powered IO driver over manual needles, and other semi-automatic IO infuson devices.
Pediatric Vascular Access and Centeses
2011, Pediatric Critical Care: Expert Consult Premium Edition
Pediatric Vascular Access and Centeses
2011, Pediatric Critical Care
Comparison of two mechanical intraosseous infusion devices: A pilot, randomized crossover trial
2009, Resuscitation
Citation Excerpt :
Fluid infused into the marrow cavity can leak out through these holes and may bias the results. The absence of overlying soft tissue allowed us to observe this flow and to make an accurate decision of proper IO placement.13–16 Participants received a 45-min general lecture on the treatment of paediatric shock, followed by two standardized educational videos on the use and the techniques of insertion of the BIG and the EZ-IO, and a 10-min demonstration on the IO model with each mechanical IO infusion device by a study investigator (YH).
Administration of medications via the intraosseous (IO) route has proven to be a lifesaving procedure in critically ill or injured children. Two mechanical IO infusion devices have been approved for use in children, the spring-loaded IO infusion device (Bone Injection Gun, BIG) and the battery-powered IO infusion drill (EZ-IO). The objective of this pilot study was to compare the success rates for insertion and the ease-of-use of the two devices.
A randomized crossover study was conducted in a local paramedic training course with 29 paramedic students participating. Participants watched two videos describing the use of the two devices, followed by a demonstration on how to use each device on a turkey bone model. Then subjects were divided into two study groups: BIG-first or EZ-IO-first. Each participant performed one insertion attempt with each device independently. All attempts were filmed by a video camera. Successful placement was defined as the visualization of fluid flow from the marrow cavity. Following the study procedure, participants completed a two-item questionnaire recording their ranking of the ease-of-use of each device and their “first choice device”.
Participants had a significantly higher one-attempt success rate with the EZ-IO than with the BIG (28/29 vs 19/29, p = 0.016), and selected the EZ-IO as their first choice (20/29). Participants of the EZ-IO-first group assessed the EZ-IO as easier to use than the BIG (p = 0.0039). The subjects of the BIG-first group found no difference in the ease-of-use between the two devices (p = 0.32).
As tested by paramedic students on a turkey bone model, the EZ-IO demonstrated higher success rates than the BIG and was the preferred device. Future studies are planned to determine which of the two devices is more appropriate for obtaining IO access in the setting of paediatric emergencies.
An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO
2009, American Journal of Emergency Medicine
Citation Excerpt :
Intraosseous access has recently been revived in adults as an alternative when conventional intravenous access may be difficult or impossible [2,10-15]. The standard IO needle has been compared with newer designed needles and, most recently, IO access devices [2,9,10,14,16-18]. Early reports of IO infusion in adults used the sternum [11,19].
Intraosseous (IO) access is an alternative to conventional intravenous access. The proximal tibia and proximal humerus have been proposed as suitable sites for IO access.
A nonrandomized, prospective, observational study comparing flow rates and insertion success with tibial and humeral IO access in adults using the EZ-IO–powered drill device was conducted. The tibia was the first site of insertion, and a second IO was inserted in the humerus if clinically indicated for the same patient.
Twenty-four patients were recruited, with 24 tibial and 11 humeral insertions. All EZ-IO insertions were successful at the first attempt except for 1 tibial insertion that was successful on the second attempt. All insertions were achieved within 20 seconds. Mean ease of IO insertion score (1 = easiest to 10 = most difficult) was 1.1 for both sites. We found tibial flow rates to be significantly faster using a pressure bag (165 mL/min) compared with those achieved without a pressure bag (73 mL/min), with a difference of 92 mL/min (95% confidence interval [CI]: 52, 132). Similarly, humeral flow rates were significantly faster using a pressure bag (153 mL/min) compared with humeral those achieved without pressure bag (84 mL/min), with a difference of 69 mL/min (95% CI: 39, 99). Comparing matched pairs (same patient), there was no significant difference in flow rates between tibial and humeral sites, with or without pressure bag infusion.
Both sites had high-insertion success rates. Flow rates were significantly faster with a pressure bag infusion than without. However, we did not find any significant difference in tibial or humeral flow rates.

View all citing articles on Scopus

View full text

Original contributionComparison of a new screw-tipped intraosseous needle versus a standard bone marrow aspiration needle for infusion

Abstract

Am J Emerg Med

Ann Emerg Med

Am J Emerg Med

Am J Emerg Med

Am J Emerg Med

Original contribution
Comparison of a new screw-tipped intraosseous needle versus a standard bone marrow aspiration needle for infusion