title: Analysis of bloodgas, electrolytes and glucose from intraosseous samples using an i-STAT(®) point-of-care analyser.
abstract: BACKGROUND
  Intraosseous access is used in emergency medicine as an alternative when intravenous access is difficult to obtain. Intraosseous samples can be used for laboratory testing to guide treatment. Many laboratories are reluctant to analyse intraosseous samples, as they frequently block conventional laboratory equipment. We aimed to evaluate the feasibility and accuracy of analysis of intraosseous samples using an i-STAT(®) point-of-care analyser.
  
  
  METHODS
  Intravenous and intraosseous samples of twenty children presenting for scheduled diagnostic bone marrow aspiration were analysed using an i-STAT(®) point-of-care analyser. Sample types were compared using Bland Altman plots and by calculating intraclass correlation coefficients and coefficients of variance.
  
  
  RESULTS
  The handheld i-STAT(®)point-of-care analyser proved suitable for analysing intraosseous samples without technical difficulties. Differences between venous and intraosseous samples were clinically acceptable for pH, base excess, sodium, ionised calcium and glucose in these haemodynamically stable patients. The intraclass correlation coefficient was excellent (>0.8) for comparison of intraosseous and intravenous base excess, and moderate (around 0.6) for bicarbonate, sodium and glucose. The coefficient of variance of intraosseous samples was smaller than that of venous samples for most variables.
  
  
  CONCLUSIONS
  Analysis of intraosseous samples with a bedside, single-use cartridge-based analyser is feasible and avoids the problem of bone marrow contents damaging conventional laboratory equipment. In an emergency situation point-of-care analysis of intraosseous aspirates may be a useful guide to treatment.
authors.affiliation: Paediatric Intensive Care Unit, UMC Utrecht, Wilhelmina Children's Hospital, The Netherlands. Electronic address: E.S.Veldhoen@umcutrecht.nl.
authors.forename: Esther S
authors.initials: ES
authors.lastname: Veldhoen
authors.affiliation: Department of Clinical Chemistry and Haematology, UMC Utrecht, Wilhelmina Children's Hospital, The Netherlands.
authors.forename: Karen M K
authors.initials: KM
authors.lastname: de Vooght
authors.affiliation: Department of Paediatric Cardiology, UMC Utrecht, Wilhelmina Children's Hospital, The Netherlands.
authors.forename: Martijn G
authors.initials: MG
authors.lastname: Slieker
authors.affiliation: Department of Paediatric Haematology and Oncology, UMC Utrecht, Wilhelmina Children's Hospital, The Netherlands.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Versluys
authors.affiliation: Paediatric Anaesthesiologist, Division of Vital Functions, Medical Director Dutch Foundation for the Emergency Medical Care of Children (Stichting SHK), UMC Utrecht, Wilhelmina Children's Hospital, The Netherlands.
authors.forename: Nigel McB
authors.initials: NM
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D001784:Blood Gas Analysis / Q000295:instrumentation*; D001786:Blood Glucose / Q000032:analysis*; D001842:Bone and Bones / Q000737:chemistry*; D002648:Child; D002675:Child, Preschool; D004573:Electrolytes / Q000032:analysis*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D004573:Electrolytes
keywords: Intraosseous; Laboratory analysis; Resuscitation; Vascular access