EXTRAVASATION RATES AND COMPLICATIONS OF INTRAOSSEOUS NEEDLES DURING GRAVITY AND PRESSURE INFUSION

Objective: To compare the extravasation rates and insertion complicati ons under gravity and 300 mm Hg (40 kPa) pressure infusion of threaded (SurFast(R) and Sussmane-Raszynski intraosseous needles, Cook Critica l Care, Bloomington, IN); and nonthreaded needles (16-gauge disposable intraosseous needle with 45 degrees trocar Cook Critical Care, Bloomi ngton, IN; Jamshidi bone marrow needle; Baxter Health Care Corp, Valen cia, CA). Design: A prospective, randomized study. Setting: An animal laboratory at a university center. Subjects: Five healthy mix breed pi glets, weighing 15 to 15.5 kg. Interventions: Piglets were anesthetize d and ventilated, Tibial, femoral, and humeral osseous sites were expo sed by dissection of overlying tissue, All bleeding points were cauter ized and oozing was prevented by sealing with cyanoacrylate, Intraosse ous access devices then were inserted one at a time in random order an d rated for difficulty of insertion, Normal saline solution was infuse d under gravity or 300 mm Hg (40 kPa) pressure, Extravasation rates th en were calculated from the increase in weight of a gauze sponge wrapp ed tightly at the base of the needle during infusion. Measurements and Main Results: No significant (p > .05) differences in extravasation r ates were noted among the different types of needles, either under gra vity or pressure infusions, The Sussmane-Raszynski needle was signific antly more difficult to insert than the others (rated difficult to ins ert and control in 16 of 34 attempts), Inadvertent penetration of both cortices occurred with nonthreaded needles only (three of 66 attempts ), The SurFast(R) needle provided greatest penetration control and was most resistant to accidental dislodgement. Conclusions: Under ideal c onditions, needle type does not influence extravasation rates, However , difficulty with insertion and penetration of both cortices occur com monly and may lead to extravasation during stressful emergency situati ons or when performed by unskilled personnel.