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A new study of intraosseous blood for laboratory analysis
Larry J Miller1, Thomas E Philbeck, Diana Montez
1Science & Clinical Department, Vidacare Corporation, Shavano Park, Texas 78249, USA.
Insights
Intraosseous (IO) blood is a reliable alternative for critical care lab tests, especially hemoglobin and hematocrit. However, results for white blood cell counts and electrolytes like sodium may differ from venous samples.
Area of Science:
- Critical Care Medicine
- Laboratory Hematology
- Clinical Chemistry
Background:
- Intraosseous (IO) blood is utilized for blood chemistry profiles in critically ill patients.
- Reliability of IO blood for laboratory analysis and optimal waste volume are not well-established.
Purpose of the Study:
- Evaluate IO-derived blood for routine laboratory tests in critically ill patients.
- Determine the appropriate volume of marrow/blood to waste before IO sample collection for analysis.
Main Methods:
- Compared venous blood samples with IO samples from 10 volunteers.
- Collected IO samples after 2 mL and 6 mL waste volumes.
- Analyzed complete blood count and chemistry profiles, comparing results using Pearson correlation coefficients.
Main Results:
- Significant correlation between venous and IO samples for RBC, hemoglobin, and hematocrit.
- Significant correlation for glucose, BUN, creatinine, chloride, total protein, and albumin.
- No significant correlation for WBC, platelets, sodium, potassium, CO(2), and calcium.
Conclusions:
- IO blood is a reliable alternative when venous access is difficult, particularly for hemoglobin and hematocrit.
- Most basic chemistry profile analytes are reliable from IO samples.
- CO(2) and platelet counts may be lower, and WBC counts may be elevated in IO samples.
Context:
Intraosseous (IO) blood is frequently used to establish a blood chemistry profile in critically ill patients. Questions remain regarding the reliability of IO blood for laboratory analysis and established criteria regarding the amount of marrow/blood to waste before taking an IO sample are not available.
Objectives:
To evaluate IO-derived blood for routine laboratory blood tests needed in the care of critically ill patients and to determine the amount of marrow/blood to waste before drawing blood from the IO space for laboratory analysis.
Design:
Blood samples were drawn from peripheral veins of 10 volunteers. Within 5 minutes, 2 IO blood samples were obtained; one following 2 mL of waste and another following 6 mL of waste. Samples were analyzed for complete blood count and chemistry profile. Values were analyzed using Pearson correlation coefficients. Levels of significance were determined using the t distribution. Mean values for the draws were calculated and compared, with the intravenous blood sample serving as a control for the IO samples.
Results:
There was a significant correlation between intravenous and IO samples for red blood cell counts and hemoglobin and hematocrit levels but not for white blood cell counts and platelet counts. There was a significant correlation between intravenous and IO samples for glucose, blood urea nitrogen, creatinine, chloride, total protein, and albumin concentrations but not for sodium, potassium, CO(2), and calcium levels.
Conclusions:
When venous blood cannot be accessed, IO blood aspirate may serve as a reliable alternate, especially for hemoglobin and hematocrit levels and most analytes in a basic blood chemistry profile. Exceptions are CO(2) levels and platelet counts, which may be lower, and white blood cell counts, which may appear elevated.
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