I have yet to use the FAST 1 in actual practice, but after training with it, it seems that there is little risk of misplacement if you follow the instructions closely. Also, the needle only penetrates to a predetermined depth - not like placing an IO in the proximal tibia in a ped - so it seems quite unlikely that one would penetrate deeply enough to infuse a large volume of fluid into the chest cavity, even if you missed the sternum altogether.
As far as tibial vs. sternal....I think that's a good question; maybe someone else on the list knows the "real" reason. I suspect that the manufacturers just found it easier to develop equipment for the sternal site since it is probably easier to penetrate the bone at the sternum (isn't the layer of bone on the anterior sternum considerably thinner than the bone on the distal tibia?), and it is also probably easier to secure the equipment and monitor the insertion site on the chest. Also, I kind of have a hard time believing that during low-flow states (shock), the central circulation is reached as quickly from the distal tibia as it is from the anterior sternum. (but I've been wrong a few times before : >)
Fly safe!
-Allan
-------------------------------------------------------
Allan D. Bulkley
NREMT-P, CCEMT-P, FP-C
Flight Paramedic, Mercy Flight Central
Canandaigua, NY
<< I have a question regarding sternal IO. I am finishing up the CCEMT-P at UMBC
and today we had cadaver lab. I did both sternal and ankle IO. When asking
the surgeons teaching the class why one would perform a sternal IO over the
ankle placement, the physician replied that there is very little difference
in delivery time to central circulation and having a double amputee would be
the only indication. The physician also stated the high risk of misplacement
and the inability to aspirate bone marrow for correct placement. He also
stated the tragic consequences for running fluid and medications into the
thorasic cavity. What is everybody else's experience with this and why do you
choose sternal placement over the distal tibia?
