Infusion of intravenous fluids distal to pneumatic antishock trousers

The pneumatic antishock trouser garment is a widely used adjunct in the stabilization of the hypotensive patient. Successful resuscitation may require infusion of intravenous (IV) solutions below the diaphragm. However, once all three sections of the pneumatic antishock trousers are inflated, the only IV access available below the diaphragm with the garment inflated is in the foot or ankle. To determine the feasibility of infusing IV solutions distal to the garment, an IV catheter was inserted percutaneously in an ankle or foot vein (saphenous if possible) of ten volunteers. With a Jobst three-section antishock air pants garment in place but deflated, each volunteer was injected via a 3-mL syringe with a measured amount of xenon 133 dissolved in 2 mL of normal saline. The 133Xe was then rapidly flushed with 250 mL of normal saline using a blood infusion hand pump. Time required for 133Xe to reach the central circulation was measured using a gamma emissions camera. The above procedure was then repeated with the garment inflated to 40 and then to 100 mm of mercury. There was no statistically significant difference in the amount of time to reach peak concentration of 133Xe in the thorax or in the time required to infuse 250 mL of normal saline via hand pump with the garment inflated to 0, 40, or 100 mm Hg. These results indicate that IV solutions may be rapidly infused under pressure distal to the pneumatic antishock trousers and reach the central circulation without significant delay.