humeral head IO

TXmed

TXmed

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recently ive been told by several smart paramedics that a humeral head IO flows just as quickly as a central line. I have noticed several ems systems going to the shoulder as there first line. I was wondering if anyone knew of more information pertaining to the matter. experience or studies
 
Depending on the type of central line, flow through most of them will be DRAMATICALLY slower than a peripheral IV. Now, if you're talking about time to reach central circulation.....
 
Per the article posted in the linked thread a Tibial IO will flown ~165ml/min with a pressure bag. CVCs come with various gauge lumens but the most common being 18g,16g, and rarely 14g. Flow rates are approximately 80ml/min, 120ml/min, and 210ml/hr respectively with pressure bags. And then a 6fr Cordis flows around 350ml/min.
 
Chase said:
Per the article posted in the linked thread a Tibial IO will flown ~165ml/min with a pressure bag. CVCs come with various gauge lumens but the most common being 18g,16g, and rarely 14g. Flow rates are approximately 80ml/min, 120ml/min, and 210ml/hr respectively with pressure bags. And then a 6fr Cordis flows around 350ml/min.
Click to expand...

But most CVC's are also double or triple lumen, meaning your effective lumen is much smaller.
 
Our tibial IOs flow slower, it seems, than our humoral sites. Both flow slower than our central lines. But we use a long 14g to access femoral or subclavian central access.
 
several days after posting this thread I actually place a humeral IO and I can say I saw it flow exceptionally fast . So much so that when we took the pressure bag off it immediately started backing up into the line... ive never seen an io do that before. Im definitely gonna start making this my first choice when I need a line for an arrest or serious call when iv cant be quickly obtained
 
usalsfyre said:
But most CVC's are also double or triple lumen, meaning your effective lumen is much smaller.
Click to expand...

I was referring to the individual lumen sizes and flow rates. The total diameter of most double or tripple lumen CVCs is 5 of 6 french. They are divided into various configurations. The 18g lumen of a double will flow the same as an 18g lumen in a tipple.


PowerLine-Lumen-Design.jpg
 
Remember that flow varies with the 4th power of the lumen, but also inversely with the length. Most triple lumens are like 20cm. So even if the triple or double lumen is only a little smaller than an IV, they flow much more slowly than a short peripheral IV. (They are great for critical care because you can sample blood off them, you can give meds like norepinephrine that you can't really give peripherally, and it is much easier to run multiple medication with one triple lumen then trying to start 3 IVs.)

http://en.wikipedia.org/wiki/Poiseuille's_law

Also found this on flow rates from Arrow who makes a lot of the kits.

http://www.arrowintl.com/products/pressurecvc/save_time/flow_rates.asp
 
TXmed said:
recently ive been told by several smart paramedics that a humeral head IO flows just as quickly as a central line. I have noticed several ems systems going to the shoulder as there first line. I was wondering if anyone knew of more information pertaining to the matter. experience or studies
Click to expand...
Not sure about flowing as quick as a central line, i believe the main purpose is to reach central circulation quicker for medications to take effect asap!
Compared to the Tibial IO it is very simple to do
 
DEmedic said:
I didn't think anything was easier than a tibial IO?
Click to expand...

Glad I'm not the only one who thought that. Heck you could probably throw the IO needle across the room and get it
 
DEmedic said:
I didn't think anything was easier than a tibial IO?
Click to expand...
In my humble experience, the manual ( no drill) humeral head IO's were way easier than tibial and the flow was great. Many a code save with this access. Unfortunately in my system, we are required to use the Easy IO drill and may only go tibial.
 
The lumen of the bone in the tibia is much smaller than the marrow space of the humeral head, this allows for increased flow that you see between the two sites.
 
Someone please remind my local community hospital that time to central circulation is not the same as flow rate.

"It's an uncontrolled hemothorax so we need to place a triple lumen central line before you transport. Have you seen how fast these are? What's that? No all of them have to be triple lumen, and no you cannot start a peripheral IV on this patient. Now get out of the...uh oh er oh damn I think I just lacerated his femoral. Ah screw it, lets just put him on Levophed drip for transfer and you can initiate blood on the ride down if you need too."

True stories of the Level IV Critical Access ED.

That RIC device looks pretty sweet.
 
jfuent268 said:
Compared to the Tibial IO it is very simple to do
Click to expand...

I have never heard anybody say that the humeral IO is easier than the tibial IO... Humeral IO is in the way of everything important, is in an area with difficulties in stabilization, with no bonus over tibial IO of which I'm aware. Who cares about flow rate? It is the rare patient where if I don't dump 2L of saline STAT they're going to die a dead death.
 
My service is now recommending a "preference" for humeral head IO access over tibial due to flow rate and time to central circulation. I get where they're coming from, but to me the potential pitfalls outweigh the supposed benefits on the majority of my patients when an IO is placed.

Translation? The majority of my IO charts now state that humeral head access was considered and proximal tibial access was chosen for reasons X and Y.
 
The county I'm doing my medic school at doesn't allow proximal tibia on adults... Not even as a base hospital order
 
Do any of you guys use FAST? We teach it in TCCC.
 
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