Complication With Intraosseous Access

Inquiry of Scandinavian Users' Experiences

Peter Hallas, MD; Mikkel Brabrand, MD; Lars Folkestad, MD

Disclosures

Western J Emerg Med. 2013;14(5):440-443. 

In This Article

Abstract and Introduction

Abstract

Introduction: Intraosseous access (IO) is indicated if vascular access cannot be quickly established during resuscitation. Complication rates are estimated to be low, based on small patient series, model or cadaver studies, and case reports. However, user experience with IO use in real-life emergency situations might differ from the results in the controlled environment of model studies and small patient series. We performed a survey of IO use in real-life emergency situations to assess users' experiences of complications.

Methods: An online questionnaire was sent to Scandinavian emergency physicians, anesthesiologists and pediatricians.

Results: 1,802 clinical cases of IO use was reported by n=386 responders. Commonly reported complications with establishing IO access were patient discomfort/pain (7.1%), difficulties with penetration of periosteum with IO needle (10.3%), difficulties with aspiration of bone marrow (12.3%), and bended/broken needle (4.0%). When using an established IO access the reported complications were difficulties with injection fluid and drugs after IO insertion (7.4%), slow infusion (despite use of pressure bag) (8.8%), displacement after insertion (8.5%), and extravasation (3.7%). Compartment syndrome and osteomyelitis occurred in 0.6% and 0.4% of cases respectively.

Conclusion: In users' recollection of real-life IO use, perceived complications were more frequent than usually reported from model studies. The perceived difficulties with using IO could affect the willingness of medical staff to use IO. Therefore, user experience should be addressed both in education of how to use, and research and development of IOs.

Introduction

Intraosseous access (IO) is indicated in critically ill patients if vascular access cannot be quickly established.[1] Complication rates with IO are estimated to be low, a notion that seems to come mainly from small patient series, model or cadaver studies, and case reports.[2–10] By convention, these studies often define "success rate" as insertion rate, i.e. the proportion of needles that penetrate the cortex. This success rate is usually high, 71–100%.[2–10]

IO is a relatively rare occurrence in many settings, and healthcare staff might be inexperienced in the procedure or unfamiliar with the available IO device. Using IO in real-life situations could pose a different set of challenges (e.g., moving patient, high-stress situation, not much room to work around, many people involved in resuscitation) compared to the often controlled settings of small patient series, model or cadaver studies. Therefore, it is possible that the rate of experienced complications is much higher in real-life emergency situations than described in small patient series, model or cadaver studies.

Users' recollection of complications with using a medical device will influence their willingness to use it in the future. Thus, information on users' experience with complication rates in real-life use of IO could be used to identify issues for improvements in education and device design. For this purpose, we collected information on what Scandinavian emergency physicians, anesthesiologists and pediatricians experienced with real-life IO use.

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