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 a validation of the sternal intraosseous infusion approach using Pyng Medical’s FASTResponder (and FASTTactical) Sternal IO devices.
As Dr. Moloff explains in the eBook, FASTResponder is a Sternal Intraosseous Infusion device was specifically designed with an emphasis on effective and easy use by the healthcare provider. It uses an ergonomic design to assist with dexterity, positioning, placement and insertion.
This design allows for rapid positioning, placement and insertion even under conditions of poor or limited lighting. FASTResponder may be used on patients 12 years of age and older. The insertion position of FASTResponder is at the sternal notch, in the manubrium at the upper or cephelad portion of the sternum. This is a readily available and easily recognizable anatomic landmark regardless of body habitus.
The manubrium (sternum) is a remarkably consistent bone regardless of the patient’s size, muscle mass, obesity or age. The bone reaches a consistent level of bone thickness, bone density and size of the bone marrow space beginning at 12 years of age. (6) The sternum (and manubrium) contains “red bone marrow”, which has a rich blood supply and is physiologically active as compared to the “yellow bone marrow” of the extremities.
This is another reason why sternal IO could be advantageous over peripheral IO (IO via the extremities). The venous system rapidly returns blood, as well as administered fluids and medications, through the superior vena cava directly to the heart.
There are extensive collateral circulation pathways for the manubrium and sternum that allow for excellent and rapid flow rates to the central vasculature. Fluids and medications that travel a much shorter distance reach the heart and vascular system much more quickly, as compared to fluids and medications administered by peripheral IV’s or IOI’s in the extremities.
This is especially true when there is cardiovascular compromise as in cardiac arrest or hypovolemia. (2,4,7) It is well known that IO infusion into the long bones is painful. It is not the penetration of the bone that causes the most pain to a patient, but rather the entry of fluid or medications into the bone marrow. The main reason for this is the density and lack of elasticity in the “yellow marrow” of the long bones. IO in the long bones usually comes with a recommendation of an initial bolus of lidocaine to decrease this pain in conscious patients. Pain from sternal IO is different and is less painful than IO into the long bones.
The initial insertion into the sternum/manubrium is similar to a thump to the chest; a dull short pain. There is virtually no pain as the initial bolus of fluid or medication flows into the bone marrow. This is because the “red bone marrow” of the sternum is less dense and much more elastic as compared to the “yellow marrow” of the long bones.
Download the full eBook, Why Sternal IO? by Dr. Moloff to learn:
- Reasons to use intraosseous infusion vs. peripheral intravenous access
- The effectiveness of intraosseous use.
- The effectiveness of the sternal route for intraosseous use
- Validation of the use of the FASTResponder Sternal IO device for intraosseous access.