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In Dr. Alan Moloff’s recent eBook, “Why Sternal IO?”, he reviews clinical data and user experiences the case for using the sternal intraosseous infusion route for vascular access.

One section of the eBook that Dr. Moloff highlights is the effectiveness of Sternal IO for intraosseous access. In the eBook, he explains that Intraosseous Infusion, the infusion of fluids and medications directly into the bone marrow, has a number of advantages as compared to peripheral IV’s:

1. Easy to Locate Anatomical Landmarks

First, the anatomic landmarks at the most common IO insertion points are easy to locate, especially via the sternal IO site. When using IO the bone marrow can be viewed as the “non-collapsible” vein; it does not role, it does not spasm, it does not collapse or disappear during shock or cardiac arrest, and it does not need to be visualized prior to insertion. The bone marrow has excellent blood supply and is not affected by environmental temperatures or blood pressure changes. The bone marrow of the manubrium (sternum) is physiologically active with extensive collateral circulation, as will be discussed later. 

2. Flow Rates 

A critical factor regarding the value and utility of IO is the flow rate; how much fluid or medication can be administered in any given time. This flow rate is often compared to flow rates of traditional peripheral intravenous or central venous line flow rates. Flow rates will vary based on a number of factors. The two most important variables are the blood pressure of the patient and the type of infusion system used. Different studies have used fresh cadavers or animal models. A recent study used “fresh cadavers” and simulated a bolus infusion (300mm/Hg pressure) over a 5 minute time period. The study tested 5 minute bolus infusion rates at the sternum, humerus and tibia.

This study demonstrated a five minute flow rate of 469 ml for the sternum, 286 ml for the humerus and 154 ml for the tibia. The mean flow rates were 93.7 ml/min for the sternum, 57.1 ml/min for the humerus and 30.7 ml.min for the tibia. (11)

3. Time to Reach the Vasculature and Achieve Peak Concentrations 

Another critical factor for the value and utility of IO is the time required for medicines to reach the vasculature and achieve peak concentrations. A study was done using an anesthetized, porcine model in cardiac arrest. This study demonstrated peak arterial concentrations achieved in 53 seconds for sternal IO, as compared to 107 seconds for tibial IO. Time for peak blood concentration was 97 seconds for sternal IO which “was similar” for central venous line administration. (12) 

Download the full eBook, Why Sternal IO? by Dr. Moloff to learn:

  1. Reasons to use intraosseous infusion vs. peripheral intravenous access
  2. The effectiveness of intraosseous use.
  3. The effectiveness of the sternal route for intraosseous use
  4. Validation of the use of the FASTResponder Sternal IO device for intraosseous access.


Download the Why Sternal IO? eBook

References Used in this Post:

11. Pasley, J., Miller, C., et. al., Intraosseous Infusion Rates under High Pressure: A Cadaveric Comparison of Anatomic Sites, AFRL-SA-WP-SR-2014-0003, U.S. Air Force Research Laboratory, JAN 2014.

12. Hoskins, SL, et. al., Pharmacokinetics of the Intraosseous and central Venous Drug Delivery During Cardiopulmonary Resuscitation, Resuscitation, JAN 2012, VOL. 83, Issue 1.

For a full list of references, download the eBook at go.pyng.com/why-sternal-io