Use of Intraosseous Access in the Pediatric Emergency Department: A Single Center Experience

Objective: We aimed to compare the efficacy of a battery-powered drill [EZ-intraosseous (IO)] with that of 18-gauge intravenous cannula (18GIVC) needle used for IO access in infants. Method: This prospective observational study was conducted in the pediatric emergency department between April 1, 2019, and November 3, 2020. Since limited number of EZ-IO needles were available, the first IO accesses were made with 18GIVC needles in all infants. In cases where IO access with 18GIVC failed at the first attempt, the second attempt was made with EZ-IO drill. The cases were divided into two groups: Group 1 (patients with IO access with 18GIVC at first successful attempt) and Group 2 (patients with IO access with EZ-IO drill at the second successful attempt). The Mann Whitney U test and Fisher’s exact or chi-square tests were used for statistical analysis, with level of statistical significance set at p<0.05. Results: Forty six infants were included in the study. In 34 (79.9%) patients the first access with 18GIVC needles was successful. Second attempt with EZ-IO drill was successful in the remaining 12 (26.1%) patients. The cases in Group 1 were younger than in Group 2 (p<0.001). All cases aged six months or younger were included in Group 1 (p<0.001). The time required for IO access with the EZ-IO drills was statistically significantly shorter compared to the that required for 18GIVC (p<0.001). Extravasation was observed in 8 cases (22.2%) within Group 1. Conclusions: Use of EZ-IO drills provides a quick, efficient, and dependable method for IO access in critically ill infants. If resources are limited, the experienced user can use the 18GIVC hypodermic needle as a last resort for IO access in critically ill infants younger than 6 months.