title: Feasibility of point-of-care colour Doppler ultrasound confirmation of intraosseous needle placement during resuscitation.
abstract: BACKGROUND
  Intraosseous needle insertion for vascular access is a standard procedure used in paediatric resuscitation. The introduction of newer automated intraosseous devices has recently expanded its role to include resuscitation in patients of all ages. Managing resuscitation can be challenging and a misplaced intraosseous needle may confound effective resuscitation. Colour Doppler ultrasound has been recently proposed as a method to confirm intraosseous needle placement. The ability to rapidly determine the correct position of an intraosseous needle during resuscitation would allow the delivery of medication or fluid infusion into the vascular space to be verified, thus optimizing resuscitation. Furthermore, complications from intraosseous infusion extravasating into soft tissues, such as compartment syndrome, or tissue necrosis can be avoided.
  
  
  METHODS
  We describe the point-of-care sonographic technique and colour Doppler ultrasound findings of intraosseous needle confirmation in a case series of critically ill patients requiring resuscitation, highlighting the utility of this sonographic application.
  
  
  RESULTS
  Colour Doppler ultrasound detected extraosseous flow in incorrectly positioned intraosseous needles, and intraosseous flow in correctly positioned intraosseous needles in six critically ill patients requiring resuscitation.
  
  
  CONCLUSIONS
  The use of point-of-care colour Doppler ultrasound to determine the location of both manually inserted or automated placement of intraosseous access during resuscitation is feasible, can be rapidly performed, may verify delivery of resuscitative medications or infusions, and avoid complications from extravasation.
authors.affiliation: Department of Paediatrics and Emergency Medicine, Bellevue Hospital Center/NYU School of Medicine, New York, NY 10016, United States. jtsung@gmail.com
authors.forename: James W
authors.initials: JW
authors.lastname: Tsung
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
authors.forename: Michael B
authors.initials: MB
authors.lastname: Stone
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D017148:Infusions, Intraosseous / Q000379:methods*; D008297:Male; D018615:Ultrasonography, Doppler, Color