title: Peripheral venous or tibial intraosseous access for medical emergency treatment in the dental office?
abstract: BACKGROUND
  The anterior tibia has been recommended as emergency vascular access site if the intravenous route cannot be used.
  
  
  OBJECTIVE
  This study aims to evaluate the peripheral venous and anterior tibial intraosseous puncture as alternatives for dentists, using a human and a cadaver model.Method One group of dental students performed a venipuncture by using a standard catheter device (n = 21) on other students. Another group (n = 24) used the Vidacare EZ-IO intraosseous kit on a cadaver tibia with india ink as a tracer. Success rates as well as the time needed for a successful puncture were recorded.
  
  
  RESULTS
  28.5% of venous and 83.3% of intraosseous punctures were successful. The relative risk of venous cannulation failure was 3.4 (95% CI 1.6-7.2; p = 0.0005). A successful venous access could be performed within 163 ± 23.2 seconds (mean ± SD), a tibial intraosseous access within 30 ± 27.8 seconds (p = 0.0003).
  
  
  CONCLUSIONS
  Within the limitation of this study, it can be demonstrated that the chances to perform a successful vascular access for inexperienced dentists may be higher when using the tibial intraosseous route for emergency intravascular medication.
authors.affiliation: University of Heidelberg, Institute for Anatomy and Cell Biology, Im Neuenheimer Feld 307, D-69120 Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Goldschalt
authors.affiliation: University of Heidelberg, Institute for Anatomy and Cell Biology, Im Neuenheimer Feld 307, D-69120 Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Doll
authors.affiliation: University of Heidelberg, Institute for Anatomy and Cell Biology, Im Neuenheimer Feld 307, D-69120 Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Ihle
authors.affiliation: University of Heidelberg, Institute for Anatomy and Cell Biology, Im Neuenheimer Feld 307, D-69120 Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kirsch
authors.affiliation: 1] University of Heidelberg, Institute for Anatomy and Cell Biology, Im Neuenheimer Feld 307, D-69120 Heidelberg, Germany [2] Mutzbauer and Partner, Maxillofacial Surgery and Dental Anaesthesiology, Tiefenhoefe 11, CH-8001 Zurich, Switzerland.
authors.forename: T S
authors.initials: TS
authors.lastname: Mutzbauer
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D003729:Dental Care / Q000379:methods*; D004630:Emergencies; D006801:Humans; D017148:Infusions, Intraosseous / Q000009:adverse effects / Q000379:methods*; D013977:Tibia; D013997:Time Factors