Determining Intraosseous Needle Placement Using Point-of-Care Ultrasound in a Swine (Sus scrofa) Model

Area of Science:

• Emergency Medicine
• Ultrasound Technology
• Surgical Procedures

Background:

• Intraosseous (IO) access is vital for rapid resuscitation when peripheral IV access fails.
• Misplacement of IO lines can lead to serious complications like extravasation and tissue necrosis.
• Current research on ultrasound for IO placement confirmation is limited, especially in models relevant to young adults.

Purpose of the Study:

• To evaluate the effectiveness of bedside ultrasound in confirming IO needle placement.
• To assess ultrasound's utility in a live animal model with bone density similar to young adult patients.
• To investigate the impact of sonographer experience on accuracy.

Main Methods:

• A randomized, blinded prospective study using 36 adult swine.
• IO devices were placed in humeri, with 53 correctly and 19 incorrectly positioned.
• Four emergency physicians assessed placement using color power Doppler (CPD) ultrasound, blinded to needle location.

Main Results:

• Overall sensitivity for confirming IO placement was 72%, with a specificity of 79%.
• Sonographers with over 4 years of experience demonstrated higher specificity (86%) in identifying incorrect placements.
• Accuracy remained consistent between initial and final assessments.

Conclusions:

• Point-of-care ultrasound with CPD did not reliably confirm IO line placement in this swine model.
• Greater sonographer experience correlated with improved accuracy in identifying malpositioned IO catheters.
• Further research is warranted on experienced sonographers using CPD for IO catheter confirmation.