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Variability in intraosseous pressure induced by saline flush of an intraosseous cannula by multiple practitioners

Lab Animal volume 41, pages 224–229 (2012)Cite this article

An Erratum to this article was published on 19 October 2012

Abstract

Intraosseous cannulation is an accepted means to achieve vascular access when peripheral venous access is not available. It is common practice to flush the intraosseous cannula with saline prior to establishing infusions. The objective of this study was to evaluate changes in intraosseous pressure during the flush procedure and to assess the variability of pressure changes induced by different practitioners. Two intraosseous cannulas were placed in an isolated cadaveric femur collected from a swine. Intraosseous pressure and the rate of change in pressure were recorded continuously during a series of saline flushes into a distal femoral intraosseous cannula by 21 members of the veterinary research staff at the authors' institution. Median peak intraosseous pressures exceeded 600 mmHg, and an inverse relationship was noted between peak intraosseous pressure and the duration of flush. Bone marrow fat emboli were grossly evident in flush effluents and their presence was confirmed by microscopic examination. Until the practitioners were informed of the pressure changes induced by the intraosseous cannula flush, few had appreciated the magnitude of the pressures that they had generated, suggesting that an instrumented intraosseous flush preparation like the one used in this study may prove useful as a training tool for flush procedures.

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Figure 1: The placement of distal (left) and proximal (right) intraosseous cannulas in a femur of a female swine collected postmortem.
Figure 2: Change (upper panel) and the rate of change (lower panel) in intraosseous pressure during one saline flush.
Figure 3: Distribution of peak intraosseous pressure induced by intraosseous cannula flushes carried out by 21 different practitioners.
Figure 4: There was a significant inverse relationship between peak intraosseous pressure and the duration of the intraosseous cannula flush (R2 = 0.923; P < 0.001).
Figure 5
Figure 6

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Acknowledgements

We thank the veterinarians, veterinary technicians and senior research staff at the US Army Institute of Surgical Research for their participation and support of this project. Funding for this project was in part provided by Advanced Medical Technology Initiative (AAMTI-1574). The content of this manuscript was presented at the 62nd AALAS National Meeting (2011) in San Diego, CA. The views expressed in this commentary are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

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  1. Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX

    Bernard J. Rubal,  Mark P. Rubal &  Melissa J. Marbach

  2. US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX

    Kathleen McKay &  Kevin R. Armstrong

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Correspondence to Bernard J. Rubal.

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Rubal, B., McKay, K., Armstrong, K. et al. Variability in intraosseous pressure induced by saline flush of an intraosseous cannula by multiple practitioners. Lab Anim 41, 224–229 (2012). https://doi.org/10.1038/laban0812-224

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