PHARMACOKINETICS FROM MULTIPLE INTRAOSSEOUS AND PERIPHERAL INTRAVENOUS SITE INJECTIONS IN NORMOVOLEMIC AND HYPOVOLEMIC PIGS

被引:31
作者
WARREN, DW
KISSOON, N
MATTAR, A
MORRISSEY, G
GRAVELLE, D
RIEDER, MJ
机构
[1] UNIV FLORIDA,WOLFSON CHILDRENS HOSP,JACKSONVILLE,FL 32207
[2] UNIV WESTERN ONTARIO,DEPT PEDIAT,LONDON N6A 3K7,ON,CANADA
[3] UNIV WESTERN ONTARIO,DEPT NUCL MED,LONDON,ON,CANADA
关键词
RESUSCITATION; CATHETERS; INDWELLING; INTRAOSSEOUS; INJECTION; INTRAVENOUS; PHARMACOKINETICS; PEDIATRICS; VASCULAR ACCESS PORTS; RADIOACTIVE TRACERS; CRITICAL ILLNESS; HEMORRHAGIC SHOCK;
D O I
10.1097/00003246-199405000-00021
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: To examine: a) the rate and extent of delivery of radioactive tracers to the central circulation from the tibial, medial malleolar, distal femoral, and humeral intraosseous sites, as well as from a peripheral intravenous site; and b) the end-tidal CO2 response to injected sodium bicarbonate at these sites. Design: Prospective, descriptive study. Setting: Animal laboratory at a university medical center. Subjects: Twenty anesthetized and mechanically ventilated piglets were cannulated with 18-gauge bone marrow needles at intraosseous sites and 22-gauge Teflon catheters in peripheral veins. A 22-gauge angiocath was placed in the right carotid artery of each subject. Drug kinetics were studied in the normovolemic and hypovolemic (acute bleeding of 25 mL/kg) states. Interventions: Sodium bicarbonate (1 mEq/kg) was injected into each of the three intraosseous and one intravenous sites with simultaneous monitoring of end-tidal CO2. A 10-min period for stabilization was allowed between injections. Aliquots of (99m)technetium were injected at randomly selected sites and blood samples were obtained at 1.5-sec intervals via carotid artery for radioactive counts. Experiments were repeated after withdrawal of 25 mL/kg of blood. Measurements and Main Results: Assessment by end-tidal CO2 monitoring after 1-mEq/kg injections of bicarbonate demonstrated a mean initial end-tidal CO2 increase at 12.8 sees and a mean maximal end-tidal CO2 increase of 8 torr (1.06 kPa), with no significant site differences noted. Radioactive tracer injections were detected in the carotid artery after 15.4 sees in normovolemic animals and after 21.4 sees in hypovolemic animals, with no significant site differences detected. The proportion of injected tracer at 2, 5, 10, 20, 30, and 40 mins identified no significant differences between various intraosseous and intravenous sites. Conclusions: Our study demonstrated similar rapid transit and proportion of bicarbonate and radioactive tracers, reaching the central circulation from multiple intraosseous sites and a peripheral intravenous site. This finding suggests that adjustments in drug dosage may not be required, using various intraosseous locations as an alternative to peripheral intravenous drug therapy.
引用
收藏
页码:838 / 843
页数:6
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