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Intraosseous needles in pediatric cadavers: Rate of malposition
Daniel Maxien1, Stefan Wirth2, Oliver Peschel3
1Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany; RZM Radiologisches Zentrum München, Pippinger Str. 25, 81245, Munich, Germany.
Resuscitation
|October 5, 2019
Summary
Intraosseous needles (ION) have high reported success rates, but this study found significant malposition rates in pediatric cadavers. Nearly half of intraosseous devices were malpositioned, indicating a need for further investigation in live patients.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Anatomy
Background:
- Intraosseous vascular access is critical in pediatric resuscitation.
- Reported success rates for intraosseous (IO) devices are typically high.
- The accuracy of intraosseous needle placement in pediatric populations requires further evaluation.
Purpose of the Study:
- To determine the malposition rates of intraosseous needles (ION) in pediatric cadavers.
- To assess the impact of age on ION malposition.
- To compare post-mortem computed tomography (PMCT) findings with reported in-vivo success rates.
Main Methods:
- Post-mortem computed tomography (PMCT) was performed on 212 pediatric cadavers.
- 38 cadavers with visible ION were included, divided into infants (<1 year) and children (≥1 year).
- Two independent readers evaluated the number and position of IONs.
Main Results:
- In infants, 47% of IONs were malpositioned, with 32% having no correctly placed access.
- In children, 39% of IONs were malpositioned, with 19% having no correctly placed access.
- Overall malposition rates were higher than anticipated based on previous literature.
Conclusions:
- Pediatric intraosseous needle placement demonstrates high malposition rates in cadaveric studies.
- These findings contrast with high success rates reported in live pediatric patients.
- Further research in living pediatric patients is necessary to reconcile these discrepancies.
