title: EZ-IO in the ED: an observational, prospective study comparing flow rates with proximal and distal tibia intraosseous access in adults.
abstract: BACKGROUND
  Intraosseous (IO) access is an important alternative to conventional intravenous access when intravenous access is difficult.
  
  
  METHODS
  A nonrandomized, prospective, observational study comparing flow rates with distal and proximal tibia IO access in adults using the EZ-IO-powered drill device. The proximal tibia was the first site of insertion, and a second IO was inserted in the distal tibia if clinically indicated. Intravenous saline infusion was started for all patients, initially without, then with a pressure bag device applied.
  
  
  RESULTS
  From September 19, 2008 to November 3, 2010, 22 patients were recruited, with 20 proximal tibial and 22 distal tibia insertions. Two patients had only distal tibia IO insertions. Five distal tibia and 3 proximal tibia insertions had no flow when initiating normal saline infusion without pressure. Upon comparing the mean flow rates without pressure bag, it is significantly faster in the proximal tibia, 4.96 mL/min, compared with distal tibia, 2.07 ml/min, difference of 2.89 ml/min (95% CI 1.20-4.58). Flow rates with pressure bags also revealed a similar result. Flow rates in the proximal tibia were significantly faster, 7.70 ml/min to that of distal tibia, 3.80 ml/min, difference of 3.89 ml/min (95% CI 1.68-6.10). In both proximal and distal tibia groups, the flow rates are also significantly faster with pressure bags compared with without.
  
  
  CONCLUSIONS
  Flow rates are significantly faster in the proximal tibia compared with the distal tibia. In addition, flow rates with pressure bags are significantly faster than without pressure bags in both groups.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, 169608 Singapore. mk82001@yahoo.com.sg
authors.forename: Boon Kiat Kenneth
authors.initials: BK
authors.lastname: Tan
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chong
authors.forename: Zhi Xiong
authors.initials: ZX
authors.lastname: Koh
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017148:Infusions, Intraosseous / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009983:Orthopedic Equipment; D013977:Tibia; D013997:Time Factors; D055815:Young Adult