Three Part Question
In [patients requiring IO access] are [specifically designed IO needles better than standard bone marrow aspiration needles] at [obtaining safe and speedy IO access]?
A 5 year old shocked child is presented to the emergency department via ambulance. Intravenous access is not possible and you decide to place an intraosseous needle. You find that the trolley has been stocked with standard bone marrow aspiration needles rather than the special intraosseous (IO) needles that you are used to. You swear loudly and eventually gain access with great difficulty using a cutdown technique. You later wonder whether you could have used the standard bone marrow needle instead.
Medline 1966-01/01 using the OVID interface.
[(exp infusions, intraosseous OR intraosseous.mp) AND (exp bone marrow OR bone marrow.mp OR biopsy, needle or jamshidi.mp)] LIMIT to human AND english AND abstracts
Altogether 75 papers found of which 74 were irrelevant or of insufficient quality. The remaining paper is shown in the table.
|Author, date and country
||Study type (level of evidence)
|Halm B and Yamamoto LG,|
|8 paramedics and 26 paediatric residents sing a turkey thigh model.
Jamshidi vs Cook||Experimental||Operator assessment of difficulty of insertion (10cm VAS)||3 vs 7.1 (p<0.001)||Model was bone only rather than bone and flesh
|Time to placement||25.5s vs 56.2s (p<0.001)|
|Incorrect placement rate||2 vs 1 (non-significant)|
The standard type of bone marrow aspiration needle appears to be better than the Cook IO needle in this study. However, the model is a poor one for clinical practice. Currently specific IO needles are more expensive than the standard bone marrow aspiration needle.
Clinical Bottom Line
Standard bone marrow aspiration needles should be used for IO infusion.
- Halm B, Yamamoto LG. Comparing ease of intraosseous needle placement: Jamshidi vs Cook. Am J Emerg Med 1998;16:420-1.