title: Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting.
abstract: OBJECTIVE
  Central venous catheters (CVCs) are often placed to resuscitate unstable emergency department (ED) patients. In an observational study, we assessed intraosseous (IO) vascular access in the hospital, and compared results to published experiences with CVC placement.
  
  
  METHODS
  Patients who would typically receive a CVC were considered for the study. Vascular access was gained using a powered IO device. Data collection included placement success, placement time, ease-of-use, satisfaction with flow rates, complications and subsequent CVC placement.
  
  
  RESULTS
  A total of 105 cases were studied from six centers. Mean age was 48.0±28.0 years and 53% were men; 85% of the patients were medical cases, and 53% were in cardiac/respiratory arrest. Of those, 48% returned to spontaneous circulation. A total of 94% of placements were successful on the first attempt. Mean time to IO access was 103.6±96.2 seconds. There was one serious complication - a lower extremity compartment syndrome. IO access costs $100/patient.
  
  
  CONCLUSIONS
  The data revealed faster and more successful IO catheter placement than reported for CVCs, few complications and high user satisfaction. For simple placements, cost savings for IO access vs. CVCs was $195/procedure. If 20% of the 3.5 million CVCs placed annually were replaced with IO catheters, cost savings could approach $650 million/year. We conclude that IO access in place of CVCs delivers high value in terms of being a safe, fast and effective mode of vascular access for patients in the hospital setting, with potentially substantial cost savings. These data indicate that IO access is a cost effective and viable alternative to problematic CVC lines.
authors.affiliation: Gulf Breeze Hospital, Baptist Hospital, Pensacola, FL - USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Dolister
authors.forename: Stephen
authors.initials: S
authors.lastname: Miller
authors.forename: Stephen
authors.initials: S
authors.lastname: Borron
authors.forename: Edward
authors.initials: E
authors.lastname: Truemper
authors.forename: Manoj
authors.initials: M
authors.lastname: Shah
authors.forename: Muriel R
authors.initials: MR
authors.lastname: Lanford
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Philbeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D062905:Central Venous Catheters / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D017148:Infusions, Intraosseous / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult