Page 87 - Journal of Special Operations Medicine - Spring 2014

Effects of Intraosseous and Intravenous Administration
of Hextend on Time of Administration and
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Hemodynamics in a Swine Model

Don Johnson, RN, PhD; James Dial, MSN; Jake Ard, BSN; Timothy Yourk, BSN;
Ellen Burke, BSN; Craig Paine, BSN; Brian Gegel, CRNA, DNAP; James Burgert, CRNA, DNAP

ABSTRACT
Introduction: The military recommends that a 500mL bo- hypovolemic shock. Numerous studies have found that
lus of Hextend be administered via an intravenous (IV) IO vascular access is an established rapid, safe, and ef-
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18-gauge needle or via an intraosseous (IO) needle for fective alternative to peripheral intravenous (IV) drug
patients in hypovolemic shock. Purposes: The purposes and fluid delivery. Also, studies have demonstrated that
of this study were to compare the time of administration IO needles can be quickly inserted. Additionally, some
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of Hextend and the hemodynamics of IV and IO routes studies show that serum pharmacologic concentrations
in a Class II hemorrhage swine model. Methods: This was for medications administered through IO sites have been
an experimental study using 27 swine. After 30% of their equivalent to those administered through traditional IV
blood volume was exsanguinated, 500mL of Hextend lines. For example, Van Hoff et al. demonstrated that
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was administered IV or IO, but not to the control group. there were no statistically significant differences be-
Hemodynamic data were collected every 2 minutes until tween IO and IV administration of morphine sulfate for
administration was complete. Results: Time for adminis- several pharmacokinetic parameters.
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tration was not significant (p = .78). No significant dif-
ferences existed between the IO and IV groups relative to IO infusions have been used in treating the entire spec-
hemodynamics (p > .05), but both were significantly dif- trum of adult trauma encountered in military casualties
ferent than the control group (p < .05). Conclusions: The including hemorrhage, traumatic injury, dehydration,
IO route is an effective method of administering Hextend. cardiovascular collapse, and burns. 9,10 However, few
studies have examined whether there are differences
Keywords: hemorrhage, shock, Hextend ; hetastarch, in IO and IV administration of medications or fluids
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battlefield in emergency scenarios. Cameron et al. compared pe-
ripheral to central circulation delivery times between IO
and IV injection using a radionucleotide technique in
normovolemic and hypovolemic canines and found no
Introduction
difference. Spivey et al. investigated the use of sodium
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Uncontrolled hemorrhage is the leading cause of prevent- bicarbonate infusion in a swine model of cardiac arrest
able death both in the military and in civilian trauma. and found the IO route was equivalent to, if not better
Historically, approximately 20% of combat casualties than, peripheral intravenous infusion to increase blood
were killed in action with hemorrhage as the major cause pH. Warren et al. compared infusion rates of normal
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of death. When a patient is in hypovolemic shock, it is saline through different IO infusion sites and at different
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essential to establish rapid and reliable vascular access. infusion pressures in both normovolemic and hypovole-
Often, in this scenario, the patient’s veins have collapsed, mic piglets. They concluded that infusions via the vari-
preventing vascular access and making the procedure not ous IO sites were similar to IV infusions. 13
only difficult but very time consuming. Furthermore, the
austere far-forward battlefield presents many additional The optimal fluid strategy for the early treatment of
environmental and tactical obstacles such as low light- trauma patients who are in hypovolemic shock remains
ing to military personnel attempting to establish vascular highly debated. However, the U.S. Military’s Committee
access. This is complicated with the potential of mass on Tactical Combat Casualty Care (C-TCCC), the group
casualties. The combination of these factors may lead to responsible for guidelines in the management of wounded
excessive delay in obtaining vascular access, resuscitation military personnel, recommends gaining vascular access
and subsequent loss of life. The intraosseous (IO) route with an 18-gauge IV. If an IV is not obtainable, they rec-
may be an effective and rapid method in gaining vascu- ommend the use of an IO route. The CTCCC further
lar access for the purpose of resuscitation for patients in recommends a 500mL bolus of Hextend that can be
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