title: Proximal humerus intraosseous infusion: a preferred emergency venous access.
abstract: OBJECTIVE
  To assess the proximal humerus intraosseous (PHIO) catheter placement as a preferred method for venous access over conventional methods, including peripheral intravenous (PIV) and central venous catheters (CVCs), during emergency room resuscitation.
  
  
  METHODS
  In phase 1, conventional methods for venous access (PIV and CVC) were assessed for all patients presenting to the emergency department resuscitation bay. Outcome measures in both phases were speed, immediate complications, and pain. CVC placement was performed when PIV access was deemed impossible or when rapid volume resuscitation was needed. In phase 2, resuscitations requiring venous access or complicated by failed PIV access attempts underwent PHIO catheter placement.
  
  
  RESULTS
  Sixty-two patients received either PIV (57) or CVC (5) catheterization, and 29 patients received 30 PHIO catheters. PHIO catheter placement was significantly faster than conventional methods (1.5 [SD 1.1] versus 3.6 minutes [SD 3.7; p < 0.001 for PIV, and 15.6 minutes [SD 6.7; p < 0.0056] for CVC). No major complications were identified in either phase. Minor complications for PIV access included extravasation and placement failure. Minor complications for CVC placement included inability to thread the guidewire. Minor complications with PHIO catheter placement included placement failure, poor flow, and catheter dislodgement. Pain scores associated with PHIO insertion and infusion were higher than those associated with PIV and CVC catheter placement.
  
  
  CONCLUSIONS
  PHIO catheter placement is significantly faster than PIV and CVC placement with increased minor complication profile and perceived pain. PHIO venous access is absolutely life saving when PIV or CVC placement is difficult or impossible.
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA. jpaxton1@hfhs.org
authors.forename: James H
authors.initials: JH
authors.lastname: Paxton
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Knuth
authors.forename: Howard A
authors.initials: HA
authors.lastname: Klausner
mesh_terms: D002406:Catheterization, Peripheral / Q000379:methods*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017148:Infusions, Intraosseous; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000473:pathology / Q000628:therapy*