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Point-of-Care Ultrasound to Identify Landmarks of the Proximal Humerus: Potential Use for Intraosseous Vascular Access.

Publication ,  Journal Article
Bustamante, S; Bajracharya, GR; Cheruku, S; Leung, S; Mao, G; Singh, A; Mamoun, N
Published in: J Ultrasound Med
April 2021

OBJECTIVES: The inability to identify landmarks is an absolute contraindication for intraosseous access. The feasibility of landmark identification using ultrasound (US) has been demonstrated on human cadavers. We aimed to study the feasibility of point-of-care US in identifying proximal humerus landmarks in living human patients. METHODS: This was a prospective cohort study conducted from May 3 to June 7, 2017, after approval from the Institutional Review Board at the Cleveland Clinic. Sixty upper extremities of 30 consenting participants across 3 distinct body mass index (BMI) groups (normal, obese, and morbidly obese) were alternately examined with a 12 L-RS linear US transducer (GE Healthcare, Chicago, IL) by 2 investigators. Six anatomic landmarks were identified: the humeral shaft, the surgical neck of the humerus, the lesser tubercle, the greater tubercle, the inter tubercular sulcus, and the target site for needle insertion on the greater tubercle. Rates of successful identification of all 6 landmarks as defined by independent agreement between the investigators were reported as estimated incidence rates with 95% bootstrap confidence interval (CI) sampling at the participant level. RESULTS: Ultrasound had an overall success rate of 0.87 (95% CI, 0.78-0.95) in identifying all 6 landmarks with slight variability among various BMI groups. After excluding the surgical neck, the overall success rate improved to 0.93 (95% CI, 0.87-0.98), with minimum variability across BMI groups and no change in the ability to identify the target site. CONCLUSIONS: Ultrasound is reliable in identifying proximal humerus intraosseous landmarks, with reasonable accuracy across various BMI groups.

Duke Scholars

Published In

J Ultrasound Med

DOI

EISSN

1550-9613

Publication Date

April 2021

Volume

40

Issue

4

Start / End Page

725 / 730

Location

England

Related Subject Headings

  • Prospective Studies
  • Point-of-Care Systems
  • Obesity, Morbid
  • Nuclear Medicine & Medical Imaging
  • Infusions, Intraosseous
  • Humerus
  • Humans
  • Cadaver
  • Anatomic Landmarks
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bustamante, S., Bajracharya, G. R., Cheruku, S., Leung, S., Mao, G., Singh, A., & Mamoun, N. (2021). Point-of-Care Ultrasound to Identify Landmarks of the Proximal Humerus: Potential Use for Intraosseous Vascular Access. J Ultrasound Med, 40(4), 725–730. https://doi.org/10.1002/jum.15442
Bustamante, Sergio, Gausan Ratna Bajracharya, Shravan Cheruku, Steve Leung, Guangmai Mao, Asha Singh, and Negmeldeen Mamoun. “Point-of-Care Ultrasound to Identify Landmarks of the Proximal Humerus: Potential Use for Intraosseous Vascular Access.J Ultrasound Med 40, no. 4 (April 2021): 725–30. https://doi.org/10.1002/jum.15442.
Bustamante S, Bajracharya GR, Cheruku S, Leung S, Mao G, Singh A, et al. Point-of-Care Ultrasound to Identify Landmarks of the Proximal Humerus: Potential Use for Intraosseous Vascular Access. J Ultrasound Med. 2021 Apr;40(4):725–30.
Bustamante, Sergio, et al. “Point-of-Care Ultrasound to Identify Landmarks of the Proximal Humerus: Potential Use for Intraosseous Vascular Access.J Ultrasound Med, vol. 40, no. 4, Apr. 2021, pp. 725–30. Pubmed, doi:10.1002/jum.15442.
Bustamante S, Bajracharya GR, Cheruku S, Leung S, Mao G, Singh A, Mamoun N. Point-of-Care Ultrasound to Identify Landmarks of the Proximal Humerus: Potential Use for Intraosseous Vascular Access. J Ultrasound Med. 2021 Apr;40(4):725–730.

Published In

J Ultrasound Med

DOI

EISSN

1550-9613

Publication Date

April 2021

Volume

40

Issue

4

Start / End Page

725 / 730

Location

England

Related Subject Headings

  • Prospective Studies
  • Point-of-Care Systems
  • Obesity, Morbid
  • Nuclear Medicine & Medical Imaging
  • Infusions, Intraosseous
  • Humerus
  • Humans
  • Cadaver
  • Anatomic Landmarks
  • 3202 Clinical sciences