title: Feasibility study of a novel intraosseous device in adult human cadavers.
abstract: OBJECTIVE
  Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers.
  
  
  METHODS
  The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers. Subjective parameters of loss of resistance, stable needle hold, easy needle withdrawal and any damage to the device were evaluated during the study. The insertion time was the objective parameter measured. Four sets of radiographs per insertion confirmed the position of the needle and identified complications.
  
  
  RESULTS
  A single physician performed 12 IO access procedures using the same device. Penetration of proximal and/or distal tibia was achieved in all instances. It was successful in the first attempt in eight (66.7%) and during second attempt in the remaining. The mean time to insertion was 4.1 ± 3.1 sec. Appropriate insertion of needle in the intra-medullary space of bone was confirmed with radiological examination in 10 (83.3%) insertions. In two occasions after penetrating the cortical layer of bone, the device overshot the intra-medullary space, as detected by radiological examination. Device got bent during insertion in one instance. There was no evidence of needle breakage or bone fracture. The needle could be withdrawn effortlessly in all instances.
  
  
  CONCLUSIONS
  The novel IO device could successfully penetrate the adult cadaver bones in most cases. Further studies are needed to confirm these results on a large sample.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Aggarwal
authors.affiliation: Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Lodha
authors.affiliation: Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Arun Kr
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Dhingra
authors.affiliation: Stanford-India Biodesign Programme, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jayant Sitaram
authors.initials: JS
authors.lastname: Karve
authors.affiliation: Stanford-India Biodesign Programme, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Srinivas Kiran
authors.initials: SK
authors.lastname: Jaggu
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Balram
authors.initials: B
authors.lastname: Bhargava
mesh_terms: D061605:Administration, Intravenous / Q000379:methods; D002102:Cadaver; D004635:Emergency Medicine / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D017148:Infusions, Intraosseous / Q000295:instrumentation* / Q000379:methods; D012151:Resuscitation / Q000295:instrumentation / Q000379:methods; D013977:Tibia / Q000000981:diagnostic imaging*