title: A new system for sternal intraosseous infusion in adults.
abstract: BACKGROUND
  Intraosseous (IO) infusion provides an alternative route for the administration of fluids and medications when difficulty with peripheral or central lines is encountered during resuscitation of critically ill and injured patients.
  
  
  OBJECTIVE
  To report the first 50 uses of a new system for emergency IO infusion into the sternum in adults, the Pyng F.A.S.T.1 IO infusion system.
  
  
  METHODS
  Six emergency departments and five prehospital emergency medical services (EMS) sites in Canada and the United States provided clinical and/or research data on their use of the IO system in a pilot study of success rates, insertion times, and complications. Indications for use included adult patient, urgent need for fluids or medications, and unacceptable delay or inability to achieve standard vascular access. A basic data set was standardized for all sites, and some sites collected additional data.
  
  
  RESULTS
  The overall success rate for achieving vascular access with the system was 84%. Success rates were 74% for first-time users, and 95% for experienced users. Failure to achieve vascular access occurred most frequently in patients (5 of 9) described subjectively by the user as "very obese," in whom there was a thick layer of tissue overlying the sternum. Mean time to achieve vascular access was 77 seconds. Flow rates of up to 80 mL/min were reported for gravity drip, and more than 150 mL/min by syringe bolus. Pressure cuffs were also used successfully, although fluid rate was controlled by clamping the line. Further research on flow rates is needed. No complications or complaints were reported at two-month follow-up.
  
  
  CONCLUSIONS
  These early data indicate that sternal IO infusion using the new F.A.S.T.1 IO system may provide rapid, safe vascular access and may be a useful technique for reducing unacceptable delays in the provision of emergency treatment.
authors.affiliation: University of British Columbia, Vancouver, Canada. amacnab@wpog.childhosp.bc.ca
authors.forename: A
authors.initials: A
authors.lastname: Macnab
authors.forename: J
authors.initials: J
authors.lastname: Christenson
authors.forename: J
authors.initials: J
authors.lastname: Findlay
authors.forename: B
authors.initials: B
authors.lastname: Horwood
authors.forename: D
authors.initials: D
authors.lastname: Johnson
authors.forename: L
authors.initials: L
authors.lastname: Jones
authors.forename: K
authors.initials: K
authors.lastname: Phillips
authors.forename: C
authors.initials: C
authors.lastname: Pollack
authors.forename: D J
authors.initials: DJ
authors.lastname: Robinson
authors.forename: C
authors.initials: C
authors.lastname: Rumball
authors.forename: T
authors.initials: T
authors.lastname: Stair
authors.forename: B
authors.initials: B
authors.lastname: Tiffany
authors.forename: M
authors.initials: M
authors.lastname: Whelan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004333:Drug Administration Routes; D004632:Emergency Medical Services; D004864:Equipment and Supplies; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D013249:Sternum