Variability in intraosseous flush practices of emergency physicians.

Area of Science:

• Emergency Medicine
• Orthopedic Procedures
• Medical Device Technology

Background:

• Intramedullary pressure during intraosseous (IO) procedures is linked to complications like bone marrow fat intravasation and pain.
• Understanding pressure dynamics is crucial for safe and effective IO access.

Purpose of the Study:

• To quantify inter-provider variability in pressures generated during initial intraosseous flush procedures.
• To investigate the relationship between flush duration and resulting intramedullary pressure.

Main Methods:

• IO cannulas were placed in proximal tibiae and humeri of cadavers.
• Intramedullary pressures were recorded using a second cannula.
• Fifteen emergency physicians performed 60 flushes, with duration and pressure continuously monitored.

Main Results:

• Median IO pressure was 903 mm Hg (range: 83-2941 mm Hg); median flush duration was 5.2 seconds.
• Significant inter-provider variability in peak IO pressure was observed (P<.001).
• An inverse, nonlinear relationship existed between flush duration and peak IO pressure.

Conclusions:

• Physician performance during IO flushes shows significant variability in generated pressures.
• A 35-fold difference in flush forces highlights the need for standardization.
• Extending flush duration over several seconds may mitigate dangerously high intramedullary pressures.