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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
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