title: Rapid vascular glucose uptake via enzyme-assisted subcutaneous infusion: enzyme-assisted subcutaneous infusion access study.
abstract: BACKGROUND
  Enzyme-assisted subcutaneous infusion (EASI), with subcutaneous human recombinant hyaluronidase pretreatment, may offer an alternative to standard intravenous (IV) access.
  
  
  OBJECTIVE
  This study's objectives were to assess paramedic (Emergency Medical Technician-Paramedic [EMTP])-placed EASI access in volunteers to determine (1) feasibility of EMTP EASI access placement; (2) subject/EMTP ratings of placement ease, discomfort, and overall EASI vs IV preference; and (3) speed of intravascular uptake of EASI infusate.
  
  
  METHODS
  Twenty adults underwent 20-gauge IV placement by 4 EMTPs, receiving a 250-mL maximal-rate IV bolus of normal saline. Next, each subject received in the other arm a 20-gauge EASI access line (with 1-mL injection of 150 U of human recombinant hyaluronidase), through which was infused 250 mL D5NS (1 g glucose was labeled with stable tracer 13C). Blood draws enabled gas chromatography/mass spectrometry (GC/MS) assessment of 13C-glucose uptake. Intravenous access and EASI access were compared for time parameters and subject/EMTP ratings. Data were analyzed with median and interquartile range, Kruskal-Wallis testing, Fisher exact test, and regression (GC/MS data).
  
  
  RESULTS
  Intravenous access and EASI access were successful in all 20 subjects. Compared with EASI access (all placed in <15 seconds), IV access took longer; but the 250-mL bolus was given more quickly via IV access. EMTPs rated EASI easier to place than IV; pain ratings were similar for IV and EASI. The GC/MS showed intravascular uptake at all time points.
  
  
  CONCLUSIONS
  Enzyme-assisted subcutaneous infusion is faster and easier to initiate than IV access; intravascular absorption of EASI-administered fluids begins within minutes.
authors.affiliation: Harvard Affiliated EM Residency Program, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Olanrewaju A
authors.initials: OA
authors.lastname: Soremekun
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Shear
authors.forename: Sagar
authors.initials: S
authors.lastname: Patel
authors.forename: Gina J
authors.initials: GJ
authors.lastname: Kim
authors.forename: Paul D
authors.initials: PD
authors.lastname: Biddinger
authors.forename: Blair A
authors.initials: BA
authors.lastname: Parry
authors.forename: Maria A
authors.initials: MA
authors.lastname: Yialamas
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thomas
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral / Q000379:methods*; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D005947:Glucose / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011994:Recombinant Proteins / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; D006821:Hyaluronoglucosaminidase; D005947:Glucose