Department of Emergency Medicine, Singapore General Hospital, Singapore, 169608 Singapore.
Am J Emerg Med. 2012 Oct;30(8):1602-6. doi: 10.1016/j.ajem.2011.10.025. Epub 2012 Jan 12.
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.
当静脉通路难以建立时，骨髓内（IO）通路是替代传统静脉通路的重要方法。
一项非随机、前瞻性、观察性研究，比较了使用 EZ-IO 动力钻设备进行成人胫骨远端和近端 IO 通路时的流速。胫骨近端是首次插入部位，如果临床上需要，在胫骨远端插入第二个 IO。所有患者均开始静脉输注生理盐水，最初不使用压力袋设备，然后使用。
从 2008 年 9 月 19 日至 2010 年 11 月 3 日，共招募了 22 名患者，其中 20 例胫骨近端和 22 例胫骨远端插入。有 2 例患者仅进行了胫骨远端 IO 插入。在不使用压力袋的情况下开始输注生理盐水时，5 例胫骨远端和 3 例胫骨近端插入物没有血流。比较无压力袋时的平均流速，胫骨近端的流速明显更快，为 4.96ml/min，而胫骨远端的流速为 2.07ml/min，差异为 2.89ml/min（95%CI 1.20-4.58）。使用压力袋的流速也显示出类似的结果。胫骨近端的流速明显快于胫骨远端，为 7.70ml/min，而胫骨远端的流速为 3.80ml/min，差异为 3.89ml/min（95%CI 1.68-6.10）。在胫骨近端和胫骨远端两组中，使用压力袋的流速也明显快于不使用压力袋的流速。
胫骨近端的流速明显快于胫骨远端。此外，在两组中，使用压力袋的流速均明显快于不使用压力袋的流速。
