Review: Bone Injection Gun

July 2003, MERGINET - From hand-sharpened needles to modern self-sheathing catheters, venous access techniques have undergone many changes over time, yet the basic problem remains unchanged: The need for venous access for critically ill or injured patients. Unfortunately, this need does not diminish despite the fact that veins may be inaccessible using conventional techniques. Into this gap steps the Bone Injection Gun.

The Bone Injection Gun, or B.I.G.™, is a spring-loaded catheter allowing rapid cannulation of the intraosseous space in both adult and pediatric patients. The technique is a simple one: The B.I.G. is simply placed over the chosen anatomic area and the spring action is triggered, placing a trochar into the intraosseous vasculature. The trochar is then removed, leaving a hollow cannula, and a standard IV setup attached.

Like many of us, I often hesitate to assume that a new product is safe and effective without seeing some proof. During my research, I found that the B.I.G. has undergone significant trial study both in the United States and abroad and has been FDA approved for use in both adult and pediatric populations. Additionally, the B.I.G. has been proven effective in both prehospital and military use. Finally, studies have also shown that the B.I.G. can be placed more efficiently than a venous cutdown.

Not content to simply read about other comparisons, I decided to do a head-to-head, albeit unscientific, test of both the B.I.G. and a standard Jamshidi® needle for this review. Similar to the experiences many of us have had in PALS or PEPP, I placed two raw chicken legs on my kitchen table to simulate pediatric bone anatomy and inserted both a Jamshidi needle and Bone Injection Gun per manufacturer’s instructions. My results were similar to those seen in more formal comparisons in that the B.I.G. was somewhat quicker to insert than the Jamshidi. I also found the quick snap of the B.I.G. more psychologically tolerable than the twisting and pushing motion necessary with the Jamshidi needle.

Overall, I was impressed with B.I.G. It represents an innovative solution to a critical problem. When caring for a critical patient, most of us would probably rather start an IV, and that remains the method of choice. However, if an IV site is not available, the B.I.G. is a ready solution to the problem at hand.

References

Calkins, M.D., Fitzgerald, G., et al, “Intraosseous infusion devices: a comparison for potential use in special operations,” Journal of Trauma , June 2000; 48(6): 1068-1074.

Hubble, M.W., Trigg , D.C. , “Training prehospital personnel in saphenous vein cutdown and adult intraosseous techniques,” Prehospital Emergency Care Apr.-Jun 2001; 5(2): 181-9.

Orlowski, J.P., Porembka, D.T., et al, “Comparison study of intraosseous, central intravenous and peripheral intravenous infusions of emergency drugs,” AM J Dis Child , Jan 1990;144(1):112-7.