Abstract
Background
Intraosseous (IO) access can be complicated by obesity. Successful placement of a
25 mm IO needle is unlikely when soft tissue depth exceeds 20 mm.
Objectives
The authors examined the relationship between body mass index (BMI), the ability to
palpate the tibial tuberosity (TT), and soft tissue depth at recommended IO insertion
sites.
Methods
Obese emergency department patients were assessed for a palpable TT and received ultrasound
measurement of the soft tissue depth at recommended IO insertion sites. Linear and
logistic regression were used to determine cut-off BMI values predicting soft tissue
depth >20 mm.
Results
Seventy-five patients were enrolled with a mean BMI of 47.2. The mean soft tissue
depth at the proximal humerus, proximal tibial, and distal tibial were 29.6 [95% CI
27.5-31.7] mm, 11.0 [8.9-13.0] mm, and 10.7 [9.4-12.1] mm, respectively. In 5 patients
without a palpable TT the soft tissue depth exceeded 20 mm at all three anatomic sites.
A BMI ≥43 and BMI ≥60 predicted a soft tissue depth >20 mm at the proximal tibia and distal tibia, respectively, while no reliable BMI
cut-off was identified at the proximal humerus.
Conclusions
In obese adults with a palpable TT or BMI ≤43 a 25 mm IO needle is likely adequate at the proximal and distal tibial insertion
sites. Empiric use of an extended 45 mm IO needle is advisable at the proximal humeral
insertion site in obese patients.
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Article Info
Publication History
Published online: June 14, 2016
Accepted:
June 12,
2016
Received in revised form:
May 21,
2016
Received:
April 28,
2016
Footnotes
☆Support: NONE. No conflicts of interest or financial disclosures.
☆☆Presentations: American College of Emergency Physicians Scientific Assembly, San Francisco, CA, October 2011.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
