A prospective evaluation of tibial insertion sites for intraosseous needles to gain vascular access in Asian neonates

Abstract

Objectives: To determine the appropriate intraosseous (IO) needle insertion site, optimal depth and success using a drill-assisted device (DAD) versus a manually inserted needle (MIN). Methods: Computed tomography scans of neonatal cadavers were analyzed. Success was based on tibial needle tip placement within the marrow cavity and contrast media distribution. Results: Nineteen cadavers (38 tibiae) were included. The overall success rate was comparable between DAD and MIN needles, but reduced in very-low birthweight (VLBW) infants. The insertion site was consistent across birth weight groups. Contrast leakage occurred overall in 15.8% and 41.7% in VLBW infants and was insignificantly greater in DAD versus MIN needles. Minimum and maximum puncture depth was adjusted for higher BW groups. Conclusion: IO needles should be placed 2 cm below and 1–2 cm medial to the tibial tuberosity. MIN needles are preferred to minimize leakage. IO depth should be modified by birth weight.