How an intraosseous access device provides fast, effective vascular access in critical care situations
The SAM IO Intraosseous Access System was created to deliver emergency drugs or fluids when intravenous access proves difficult as a result of patient anatomy and physiology
Sponsored by Medline
By Sarah Calams for EMS1 BrandFocus
Nearly a century ago, Dr. Cecil K. Drinker, a Harvard physician, introduced the concept of intraosseous access.
He described the bone marrow cavity as a "non-collapsible vein," which meant physicians could use this as an alternative to administer drugs or fluids when intravenous access could not be attained.
Twenty years later, Dr. Leandro Tocantins, a professor at Jefferson Medical College in Philadelphia, introduced the intraosseous access (IO) procedure in the sternum. His IO procedure, which was primarily performed in pediatric patients, became the standard of care in the Pediatric Advanced Life Support Protocol in the early 1980s.
The original IO devices were simplistic – many were outfitted with just a stylet and catheter. Insertion was completed by a manual back and forth twisting motion for the stylet and catheter to go through the bone.
Today, IO devices, like the SAM IO Intraosseous Access System, are much more advanced, offering fast and effective vascular access like never before.
Advantages of an IO device
The use of an IO device comes into play any time a vein collapses, making it difficult for physicians or EMS providers to insert an IV. Its purpose is to provide immediate needle response for fluid introduction to stabilize a patient. Once stabilized, an IV usually takes its place.
While the main patient demographic is pediatric patients due to their small, inaccessible veins, IO devices are used just as much on adults. Situations leading to vein collapse vary, but can be caused by complications such as trauma, massive blood loss and cardiac arrest.
The SAM IO Intraosseous Access System, which does not require batteries for operation, is a manually operated IO system. Its rotational force with cutting flutes acts as a screw or drill into the bone – providing an easier path of entry.
Catheter placement is accomplished by continually compressing the driver's trigger assembly while guiding needle assembly into position. In turn, repeated trigger actuation creates rotation spin of the needle assembly, resulting in successful IO placement.
It includes a driver, three needle sizes (15 mm, 25mm, 45 mm), a SAM Stabilizer, which prevents an external force from bumping against and shifting the position of a needle, and SAM Adaptor, which attaches to the driver and accommodates alternative needles.
"We found that in the prehospital setting, having to rely on a battery is problematic," Lance Hopman, director of research and development at SAM Medical, said. "You don't know when the charge is going to run out and you're left with an inoperable device. With our device, you're relying on your hand power and that's never going to go away."
Additionally, not having to check or rely on battery powered devices before, during or after responding to calls is one less thing EMS providers must worry about.
"They won't have that concern or ongoing maintenance with this device," Travis McGowan, senior product manager at SAM Medical, said.
A long-term, long-lasting device
The 2.5-ounce, polycarbonate driver, according to McGowan, has been tested and cleared for over 10,000 actuations. "This makes it a long-term, long-lasting device," he said.
The driver's light weight, according to McGowan, will be one less burden in an EMS provider's bag. "I know weight is always a big concern on that side," he said.
However, he also recommends EMS organizations focus their training on light pressure. "It's more about the actuation and rotation of the needle … start with light pressure and then build your way up until you get a feeling that you are cutting bone, and then let the driver do its job."
In order to prevent users from applying added pressure, the company incorporated a spinning cap to minimize incorrect usage and technique.
"People wanted to leverage their non-dominant hand against the back of the driver and push down that way," McGowan said. "The spinning cap spins with the device, which prevents people from getting that extra leverage from their second hand to push against it."
The device, McGowan said, was created to help save lives and provide users with the proper equipment in critical care situations – something Kyle Sims, a military veteran and director of new product development at SAM Medical, understands first-hand.
Saving lives in the prehospital setting
Sims' first use of an IO in the military was in a clinic in Afghanistan.
"I saw a child under a year old with severe burns," he said. "After failing several attempts to gain IV access, I attempted IO access, which failed in the first attempt but was successful and used to resuscitate the child while we were waiting for a medevac helicopter."
The situation, he said, was not unlike any other than a paramedic might face in EMS. "The only difference was the limited treatment equipment we had compared to what many ambulances are normally equipped with," he said.
The SAM IO, he said, incorporates the best qualities of the current manual devices, but also offers the efficiency of a drill without giving up the tactile feel that aids in proper placement or increasing logistical requirements of battery-operated devices.
"While stressful situations and difficult anatomy can make an IO slightly more difficult, IVs can become nearly impossible in stressful environments, especially when combined with difficult anatomy and physiology," Sims said.
As for advice, Sims said paramedics who are using it in the field for the first time must remember one thing: do not force it.
"Know the anatomical landmarks and take advantage of the tactile feel that the SAM IO provides," he said. "The needle will cut through the bone. Let the needle do its work. Don't force it. Concentrate on feeling it gently 'pop' into the bone marrow cavity."
Throughout his time in the military, Sims said they began utilizing more and more IO devices for trauma resuscitation and it is currently a preferred route for patients in cardiac arrest.
Similarly, as the number of IO procedures have risen in the hospital setting, it has also increased in the prehospital setting.
"As EMS directors continue to see the benefit of IO devices, they will become more routine for the paramedics they oversee," he said. "IO devices are not just useful, but necessary to save lives in the chaotic prehospital environments."
The SAM IO Intraosseous Access System is available through Medline.
Read next: How intraosseous infusion changed EMS
Request information from Medline