Is blood taken from intraosseous cannulation usable for laboratory assays in the acute setting?

In the emergency setting the use of intraosseous cannulation and infusion is
becoming more widely used. In need of fast access it is a save method for
gaining access to the vascular system to infuse drugs and fluids when access
through the peripheral venous route is difficult or impossible. It is under
debate whether blood taken from intraosseous cannulation can be used for blood
analysis. It would be an enormous advantage to the patient in the acute setting
if blood obtained from intraosseous cannulation could also be used for
laboratory assays. Important laboratory results will be faster known and
consequently treatment will be started in an earlier stage. However, there is
currently no evidence that reliable and comparable to peripheral venous levels
can be obtained in blood samples taken from intraosseous cannulation in the
acute setting.

To assess the comparability of routine blood analysis from intraosseous
cannulation and peripheral venous blood in the emergency setting.

Non-therapeutic, prospective, descriptive study

The only deviation from the standard procedure is the earlier use of
intraosseous cannulation. An intraosseous cannulation is regularly being used
in critically ill patients for the infusion of fluids. The usage is even being
recommended by European and American guidelines. Our research population is
only one step away in receiving an intraosseous cannula using the standard
protocols. The potential risk for patients in this study will be the use of
the intraosseous cannula, which is generally regarded as a safe method.
Complications that may occur include the release of bone and/or fat fragments
in the circulation, fracture at the entrance site, local infections of the bone
or skin, subcutaneous spill of infusion fluids and the compartment syndrome.
Research has shown that these complications are rare. Reported incidence varies
from 0.9% to 4.8%. Risk of complications are even less as has been described
for (deep) venous catheters in which complications such as infection, arterial
puncture, pneumothorax and thrombosis. In addition, insertion of such a
catheter is more time consuming than that of an intraosseous canulla (2,3min
vs. 9.9min). Moreover, change of success is much larger by using an
intraosseous canulla.
Not inserting an intraosseous canulla could be a greater risk to the patient in
case of an emergency, as fluids and/or medication cannot be administered on
time, which could be potentially fatal. This justifies the minimal risk of
using an intraoseous canulla. In some instances the infusion of fluids through
an intraoseous canulla can be painful, which can easily be treated by using
lidocain before infusion. However, most patients will be unconscious.
Patients in the study protocol will only endure minimal discomfort and risks
for complications are minimal.