Abstract

A short cut review was carried out to establish whether screw tipped intraosseous needles were better than standard intraosseous needles. Altogether 35 papers were found using the reported search, of which one presented 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 this best paper are tabulated. A clinical bottom line is stated.

Clinical scenario

A 50 year old alcoholic man presents to the emergency department by ambulance. He is known to have been fitting for the past 20 minutes. He has a Sao₂ of 90% on oxygen mask and tolerates an oral airway. You are unable to obtain IV access and his vigorous movements will make central venous access difficult and possibly dangerous. You decide to place an intraosseous needle in the sternum. You use your standard IO needle but struggle to get through the bone cortex. Your consultant suggests buying some screw tipped cannula to aid insertion. You wonder if they would be any better.

Three part question

In [patients requiring IO access] is [a screw tipped IO needle better than a standard needle] at [rapidly easing insertion and ensuring correct placement]?

Search strategy

Medline 1966-01/04 using the Ovid interface. [exp Infusions, intraosseous OR IO.mp. OR intraosseous.mp.] AND [screw.mp.]

Search outcome

Altogether 35 papers were found of which one was relevant to the three part question (see table 5).

Comment(s)

A previous study by the above authors showed no benefit for standard IO needles compared with standard bone marrow needles for IO access. In clinical practice IO infusion is a comparatively rare event, often performed by junior staff with little prior experience of the procedure, the levels of training/experience used in this study are probably realistic. The time differences for insertion are not clinically important. The ease of insertion scores are important and show a clear benefit for the standard needle, however the most important clinical outcome is successful placement of the IO needle. The study shows an improvement in successful placement of the screw tipped needle once the students had practised the technique. The authors conclude that there is no benefit to screw tip needles. We believe that the potential improvement in successful placement with little difference in time to successful placement is clinically important.

CLINICAL BOTTOM LINE

Screw tip IO needles are more difficult to insert but have a higher success rate.