title: Confirmation of intraosseous cannula placement based on pressure measured at the cannula during squeezing the extremity in a piglet model.
abstract: OBJECTIVE
  We sought to assess the reliability of the method using the pressure measured at the intraosseous (IO) cannula while squeezing the involved limb (P(squeezing)) in determining the position of the IO needle and to compare its performance with that of the traditional confirmation method.
  
  
  METHODS
  Eighty limbs of twenty domestic swine were assigned to one of three conditions regarding the position of the IO needle; correct placement (n=40), incorrect placement in which the IO needle was placed into the subcutaneous space without entering the bone (incorrect-subcutaneous placement, n=20), or incorrect placement in which the IO needle passed entirely through the bone (incorrect-penetrating placement, n=20). A blinded investigator randomly identified the position of the needle by the traditional method or test method using P(squeezing). If P(squeezing) was 80 mmHg or higher, the IO cannula was regarded as incorrectly placed.
  
  
  RESULTS
  P(squeezing) was higher in incorrect placements (176.0 mmHg (130.0-195.0)) compared with that in correct placements (27.0 mmHg (20.0-34.0)) (p<0.001). The test method correctly identified all 40 placements, but the traditional method was incorrect for one (5%) of 20 correct placements (p=1.000) and 7 (35%) of 20 incorrect placements (p=0.008). In incorrect placements, false positive results occurred mainly in incorrect-penetrating placements.
  
  
  CONCLUSIONS
  We suggest that the method using the pressure measured at the IO cannula can be used when there is uncertainty about the position of the IO cannula after determination using traditional methods.
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: bbukkuk@hanmail.net.
authors.forename: Byung Kook
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: neoneti@hanmail.net.
authors.forename: Kyung Woon
authors.initials: KW
authors.lastname: Jeung
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: apostlelee@hanmail.net.
authors.forename: Hyoung Youn
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Myongji Hospital, 697-4, Hwajung-dong, Deokyang-gu, Goyang, Gyeonggi-do, Republic of Korea. Electronic address: dorinim@gmail.com.
authors.forename: Seung Joon
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: gabddoli@lycos.co.kr.
authors.forename: Sei Jong
authors.initials: SJ
authors.lastname: Bae
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: sehh9943@naver.com.
authors.forename: Yong Deok
authors.initials: YD
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, Republic of Korea. Electronic address: moonks@chonnam.ac.kr.
authors.forename: Kyung Sub
authors.initials: KS
authors.lastname: Moon
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: docheo@hanmail.net.
authors.forename: Tag
authors.initials: T
authors.lastname: Heo
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: minyi46@hanmail.net.
authors.forename: Yong Il
authors.initials: YI
authors.lastname: Min
mesh_terms: D000818:Animals; D001842:Bone and Bones; D002404:Catheterization / Q000379:methods*; D057785:Catheters; D005121:Extremities; D008297:Male; D023421:Models, Animal; D011312:Pressure; D013552:Swine
keywords: Catheters; Intraosseous infusions; Pressure; Resuscitation