#EMRAP ## November 2023 Episode ### Hemolysis from Push/Pull > Syringe technique leads to too much hemolysis in blood transfusions – I actually teach military medics to NOT use this technique for that reason.  See EMA May 2018 Abstract 19 #### De Villiers et al. Transfusion 2017;57:2747 Took a 20 ml syringe and pulled as hard as they could and then pushed as hard as they could vs. a pressure bag to 300 mm Hg S18 1.28% hemolysis S22 1.13% with 1% considered cutoff and similar values for Free HB #### Miller & Schlueter. Transfusion 44, no. 3 (2004): 373–81 Syringing did not cause hemolysis with <23 G needle 18 G with gentle pull had negligible free Hb #### Bianchi et al. Military Medicine 2020;185(S1):121 20 ml Syringe compared to the Lifeflow commercial device 0.04 g/dl for push/pull **60 ml syringe** ### Pressurizing IOs > Pressure absolutely does increase your flow rates through an IO.  I completely disagree with Scott’s bottom line.  We have tons of published flow rate data on this topic – both unpressurized and pressurized.  His bottom line is just erroneous. #### Will pressure overcome the limitations of an IO? No Best rates I have seen with pressure Sternal 80, Humeral 50-60, Tibia 30-40 ml/min (10.1097/TA.0000000000000516) Tibia 204 ml/min Humeral 148 ml min??? ([10.1007/s12245-009-0116-9](https://doi.org/10.1007%2Fs12245-009-0116-9))--super sketchy humerus, 57.1 (43.5) mL/min; and tibia, 30.7 (18.7) mL/min ([10.1097/TA.0000000000000516](https://doi.org/10.1097/ta.0000000000000516)) Needs to be In vivo, b/c the needle size is not the rate limiting step ### Introducer with Pressure Rates 333 ml From the ETM Course Experiment 9 F Mac 500 ml/min 16 G IV 215  AANA Journal 2017;85(4):256 ### Some Studies done with Claves interposed