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Comparison of Intraosseous, Arterial and Venous Blood Sampling for Laboratory Analysis in Haemorrhagic Shock
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Abstract

Introduction Intraosseous (IO) access is often indicated for administration of drugs and fluids in emergencies when venous access is challenging. There is no consensus regarding which laboratory analyses may be performed on IO aspirates, and research on hemodynamically unstable subjects is limited.

Methods 12 anaesthetised pigs were sampled from IO, venous and arterial accesses during stable circulation and after haemorrhage corresponding to 20% and 40% of the blood volume. Samples were analysed for blood gases and acid-base status, electrolytes, haematocrit, creatinine, glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (γ-GT), alkaline phosphatase (ALP) and creatine kinase (CK).

Results Average differences of blood gases and acid-base parameters, sodium, creatinine, haematocrit, ALT and γ-GT and between IO and venous samples were small at baseline and after haemorrhage while differences for lactate and glucose increased with hypovolaemia. Both IO-arterial and venoarterial differences in acid-base parameters increased with hypovolaemia. Dispersions of differences were often large.

Conclusions Average levels of blood gases, acid base parameters, haematocrit, creatinine and ALT, but not lactate and glucose, were similar in IO and venous samples in hypovolaemia. However, precision was limited, indicating that IO test results should be confirmed when other vascular access is established, and that analysis of IO samples should be limited to acute situations and not used for detailed diagnostics in this setting.

Keyword [sv]
Intraosseous access, shock
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-321402OAI: oai:DiVA.org:uu-321402DiVA: diva2:1092934
Available from: 2017-05-04 Created: 2017-05-04 Last updated: 2017-05-04
In thesis
1. Experimental Studies on Diagnostic and Therapeutic Aspects of Intraosseous Access
Open this publication in new window or tab >>Experimental Studies on Diagnostic and Therapeutic Aspects of Intraosseous Access
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Reliable access to the circulation is paramount in most medical and surgical emergencies. When venous access cannot be expediently established, intraosseous (IO) access is indicated. This method has a high success rate even in relatively inexperienced hands and there is considerable clinical experience of IO administration of drugs and fluids. There is however limited evidence on the use of IO samples for laboratory analysis. Also, uptake of drugs during shock has not been extensively studied. Further, there have been concerns that analysis of IO samples may damage laboratory equipment. We have studied, in a porcine model, the use of IO samples for point of care analysis of blood gases, acid base parameters and blood chemistries in stable circulation, in experimental septic shock, and in hypovolemia after major hemorrhage, comparing IO samples with arterial and venous samples, and comparing IO samples from different sites. We have also studied coagulation assays on IO samples in stable circulation and after major hemorrhage. Furthermore, we have compared IO and intravenous administration of antibiotics in experimental sepsis.

Average differences between IO and arterial/venous samples varied between the studied analytes. During stable circulation, average IO levels of blood gases, acid-base parameters, hemoglobin/hematocrit and several blood chemistries approximated venous levels relatively well. Differences in acid-base and blood gas parameters, and lactate, were more pronounced in hypovolemia, as well as in sepsis. The dispersion of the differences was often relatively large, indicating limited precision. Average differences between two intraosseous sites were small.

Intraosseous samples were clinically hypercoagulable with a strong tendency to clot in vitro, and thromboelastography demonstrated shortened reaction times compared with venous samples. Major bleeding and hemodilution moderately affected the studied coagulation parameters.

In endotoxemic animals with circulatory instability, concentrations of cefotaxime and gentamicin in samples from the pulmonary artery were comparable at 5 minutes after intraosseous and intravenous administration, and during a 3 hour observation period.

In summary, agreement between analytes in intraosseous and conventional blood samples was variable and often unpredictable, especially during circulatory compromise. Intraosseous samples clinically appeared hypercoagulable, and thromboelastography confirmed this. High and comparable concentrations of cefotaxime and gentamicin were found after intraosseous and intravenous administration of equivalent doses, suggesting that uptake is acceptable during septic instability.  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 55 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1337
Keyword
Infusions, Intraosseous, Sepsis, Point-of-care Systems, Blood Coagulation, Antibiotics
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-321403 (URN)978-91-554-9937-2 (ISBN)
Public defence
2017-09-01, Hedstrandsalen, Akademiska Sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-06-07 Created: 2017-05-04 Last updated: 2017-08-09

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