Intraosseous Versus Central Venous Catheter Utilization and Performance during Inpatient Medical Emergencies

Peter M J Lee, Christina Lee, Peter Rattner, Xiaoping Wu, Hayley Gershengorn, Samuel Acquah

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objectives: Intraosseous access is a rapid and effective route of fluid and drug administration. Its use has been proven in emergency medicine, pediatrics, and the military. We aimed to assess its performance and utilization against landmark-guided central venous catheter placement during inpatient medical emergencies. Design: Prospective observational study. Setting: Eight hundred fifty-six-bed urban teaching hospital. Patients: Adult inpatients requiring central venous access during medical emergencies. Interventions: Intraosseous device training was added to standard central venous catheter training beginning in February 2012. Intraosseous were used as primary access in cardiac arrests and secondary access if central venous catheter placement failed during noncardiac arrest emergencies. An online survey was conducted among intraosseous and central venous catheter operators to assess their experience and any barriers to use. Measurements and Main Results: Seventy-nine adults had central access placement from February 2012 to July 2013. Sixty were during medical emergency team calls, and 19 were cardiac arrests. Thirty-one received intraosseous device, and 48 received a central venous catheter. First-pass success was significantly higher for intraosseous than for central venous catheter (90.3 vs 37.5%; 95% CI, 80-101 vs 24-51; p < 0.001). Mean placement times were significantly shorter for intraosseous than for central venous catheter (1.2 vs 10.7 min; p < 0.001). There were a total of 33 intraosseous versus 169 central venous catheter attempts with fewer attempts on average per patient during intraosseous placement (1.1 vs 2.8; p < 0.001). There were three intraosseous-related complications and 22 central venous catheter-related complications. Our survey showed high satisfaction with intraosseous training and operation. Among the barriers cited, timely intraosseous kit acquisition was most common. Conclusions: It is feasible to incorporate intraosseous use during medical emergency team calls. Intraosseous had significantly higher first-pass success rates and faster placement compared with central venous catheters. Intraosseous operators reported high satisfaction and confidence in its use. Prospective randomized studies comparing intraosseous and central venous catheter are warranted.

Original languageEnglish (US)
Pages (from-to)1233-1238
Number of pages6
JournalCritical Care Medicine
Volume43
Issue number6
DOIs
StatePublished - Jun 20 2015

Fingerprint

Central Venous Catheters
Inpatients
Emergencies
Heart Arrest
Drug Administration Routes
Prospective Studies
Equipment and Supplies
Urban Hospitals
Teaching Hospitals
Observational Studies

Keywords

  • central venous catheterization
  • intraosseous
  • intraosseous infusions
  • rapid response team
  • resuscitation
  • training

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Intraosseous Versus Central Venous Catheter Utilization and Performance during Inpatient Medical Emergencies. / Lee, Peter M J; Lee, Christina; Rattner, Peter; Wu, Xiaoping; Gershengorn, Hayley; Acquah, Samuel.

In: Critical Care Medicine, Vol. 43, No. 6, 20.06.2015, p. 1233-1238.

Research output: Contribution to journalArticle

Lee, Peter M J ; Lee, Christina ; Rattner, Peter ; Wu, Xiaoping ; Gershengorn, Hayley ; Acquah, Samuel. / Intraosseous Versus Central Venous Catheter Utilization and Performance during Inpatient Medical Emergencies. In: Critical Care Medicine. 2015 ; Vol. 43, No. 6. pp. 1233-1238.
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abstract = "Objectives: Intraosseous access is a rapid and effective route of fluid and drug administration. Its use has been proven in emergency medicine, pediatrics, and the military. We aimed to assess its performance and utilization against landmark-guided central venous catheter placement during inpatient medical emergencies. Design: Prospective observational study. Setting: Eight hundred fifty-six-bed urban teaching hospital. Patients: Adult inpatients requiring central venous access during medical emergencies. Interventions: Intraosseous device training was added to standard central venous catheter training beginning in February 2012. Intraosseous were used as primary access in cardiac arrests and secondary access if central venous catheter placement failed during noncardiac arrest emergencies. An online survey was conducted among intraosseous and central venous catheter operators to assess their experience and any barriers to use. Measurements and Main Results: Seventy-nine adults had central access placement from February 2012 to July 2013. Sixty were during medical emergency team calls, and 19 were cardiac arrests. Thirty-one received intraosseous device, and 48 received a central venous catheter. First-pass success was significantly higher for intraosseous than for central venous catheter (90.3 vs 37.5{\%}; 95{\%} CI, 80-101 vs 24-51; p < 0.001). Mean placement times were significantly shorter for intraosseous than for central venous catheter (1.2 vs 10.7 min; p < 0.001). There were a total of 33 intraosseous versus 169 central venous catheter attempts with fewer attempts on average per patient during intraosseous placement (1.1 vs 2.8; p < 0.001). There were three intraosseous-related complications and 22 central venous catheter-related complications. Our survey showed high satisfaction with intraosseous training and operation. Among the barriers cited, timely intraosseous kit acquisition was most common. Conclusions: It is feasible to incorporate intraosseous use during medical emergency team calls. Intraosseous had significantly higher first-pass success rates and faster placement compared with central venous catheters. Intraosseous operators reported high satisfaction and confidence in its use. Prospective randomized studies comparing intraosseous and central venous catheter are warranted.",
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