title: Comparison of COMPUTED TOMOGRAPHY Image Quality Using Intravenous vs. Intraosseous Contrast Administration in Swine.
abstract: BACKGROUND
  Vascular access is essential in managing patients with significant injuries. It is required for medications, fluids, blood products, and radiographic contrast administration. Generally, this is accomplished through peripheral intravenous (i.v.) cannulation. In some patients, however, i.v. cannulation may be difficult or impossible. Intraosseous (i.o.) access is an acceptable alternative for many uses during resuscitation. However, adequacy of vascular enhancement with i.o. administration of contrast has not been studied.
  
  
  OBJECTIVE
  This study was performed to assess the efficacy of i.o. administration of contrast agents for enhanced computed tomography (CT) imaging of the chest and abdomen.
  
  
  METHODS
  We carried out a crossover study in mature mini-swine with peripheral i.v. and i.o. access established. Intraosseous access was obtained in the proximal humerus with fluoroscopic confirmation. Each animal underwent two trauma-protocol CT scans successively using the i.v. or i.o. routes of contrast administration. Wash-out between studies was established. The order for route of administration was randomized. Images were evaluated for adequacy of enhancement by two blinded board-certified radiologists.
  
  
  RESULTS
  All images obtained with successful administration of i.o. contrast were judged adequately enhanced, whereas two from the i.v. route were judged to be inadequate by at least one of the radiologists. Two occurrences of failed i.o. needle placement occurred. One animal had complete contrast extravasation resulting in inadequate opacification.
  
  
  CONCLUSIONS
  In this model, injection of contrast through a proximal humerus i.o. resulted in adequate enhancement of trauma-protocol CT images. Our results suggest that i.o. administration of contrast merits further investigation of its potential utility in patients when i.v. access would delay diagnostic evaluation.
authors.affiliation: Division of Critical Care, Department of Emergency Medicine, Albany Medical Center, Albany, New York.
authors.forename: Jason
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Division of Critical Care, Department of Emergency Medicine, Albany Medical Center, Albany, New York.
authors.forename: Luke
authors.initials: L
authors.lastname: Duncan
authors.affiliation: Department of Emergency Medicine, Albany Medical Center, Albany, New York.
authors.forename: Wayne
authors.initials: W
authors.lastname: Triner
authors.affiliation: Division of Critical Care, Department of Emergency Medicine, Albany Medical Center, Albany, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rea
authors.affiliation: Department of Radiology, Albany Medical Center, Albany, New York.
authors.forename: Gary
authors.initials: G
authors.lastname: Siskin
authors.affiliation: Department of Emergency Medicine, Albany Medical Center, Albany, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: King
mesh_terms: D061605:Administration, Intravenous; D000818:Animals; D003287:Contrast Media / Q000008:administration & dosage*; D018592:Cross-Over Studies; D006811:Humerus; D007089:Image Enhancement; D017148:Infusions, Intraosseous; D007472:Iohexol / Q000008:administration & dosage*; D011897:Random Allocation; D016037:Single-Blind Method; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: CT scan; contrast; intraosseous; trauma; vascular access