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Injury. 2015 Nov;46(11):2239-42. doi: 10.1016/j.injury.2015.08.029. Epub 2015 Sep 11.

Double-barrelled resuscitation: A feasibility and simulation study of dual-intraosseous needles into a single humerus.

Author information

1
Trauma and Emergency Services, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, Canada T5H3V9. Electronic address: matthew.douma@albertahealthservices.ca.
2
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. Electronic address: gbara@ualberta.ca.
3
Shock Trauma Air Rescue Society, Edmonton, Canada. Electronic address: dodochartaigh@stars.ca.
4
Neurosciences Intensive Care, Alberta, Canada. Electronic address: Peter.Brindley@albertahealthservices.ca.

Abstract

INTRODUCTION:

Resuscitation can be delayed, or impaired, by insufficient vascular access. This study examines whether dual-intraosseous needles, inserted into a single porcine humerus, can facilitate rapid and concomitant fluid and medication delivery.

METHODS:

After inserting one- and then two-intraosseous needles into the same porcine humerus, we determined the rate of fluid administration using (i) an infusion pump set to 999mL/h, and (ii) a standard pressure-bag set to 300mmHg. Next, we concomitantly infused blood, crystalloid and medications into the same medullary canal, using the two-needle set-up. Humeri were inspected for fluid-leakage, needle-displacement, and bone damage.

RESULTS:

Using an infusion pump, the mean normal-saline infusion-rate was significantly higher with dual-intraosseous needles compared to a single-intraosseous needle: the infusion-rate was 16mL/min using dual-needles versus 8mL/min for a single needle set-up (p<0.001). In contrast, using the pneumatic pressure-bag, the infusion rate was not statistically different when comparing dual-intraosseous needles versus single-intraosseous: the infusion-rate was 22mL/min versus 21ml/min (p=0.4) for 500mL, and 22ml/min versus 21ml/min (p=0.64) for one-litre, respectively. Blood product could be infused at a mean rate of 20mL/min through one needle while tranexamic acid was simultaneously infused through a second. There were no complications with a dual-intraosseous set-up (no fluid leakage; no needle-displacement; no high-pressure alarms, and no external bone-fractures or internal macrohistological damage) during any of our simulated resuscitation scenarios.

CONCLUSIONS:

This is the first published study evaluating dual-intraosseous needles in a single bone. Despite limitations, this preliminary study (using a porcine humerus) suggests that dual-intraosseous needles are feasible. For critically-ill patients with limited insertion sites, dual-intraosseous (a.k.a. 'double-barrelled resuscitation') may facilitate rapid and concurrent resuscitation.

KEYWORDS:

Fluid administration; Intraosseous; Polytrauma; Resuscitation; Vascular access

PMID:
26372229
DOI:
10.1016/j.injury.2015.08.029
[Indexed for MEDLINE]

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