The document provides instructions for using the FAST1 Sternal Intraosseous device to access the central vasculature through the sternum bone. The device can be used when peripheral IV access has failed or is inadequate. It inserts a needle cluster perpendicular to the sternum surface to penetrate the bone and provide equivalent access to a central line. Precautions are given for patient size and bone fractures. Instructions detail preparing the device, insertion at a perpendicular angle to the sternum, securing the device, initiating fluid flow, and addressing potential problems.

1. 1Copyright 2006 - Pyng Medical Corp.
FAST1 Sternal IntraosseousFAST1 Sternal Intraosseous
Device InsertionDevice Insertion

2. 2Copyright 2006 - Pyng Medical Corp.
INDICATIONSINDICATIONS
• Inadequate peripheral vasculatureInadequate peripheral vasculature
• Failed peripheral IV attemptsFailed peripheral IV attempts
• Rapid central vasculature accessRapid central vasculature access

3. 3Copyright 2006 - Pyng Medical Corp.
TYPICAL PROTOCOL PRECAUTIONSTYPICAL PROTOCOL PRECAUTIONS
FAST1 NOT RECOMMENDED IFFAST1 NOT RECOMMENDED IF::
• Patient is of small stature:Patient is of small stature:
– 40-50 Kg. minimum recommended size40-50 Kg. minimum recommended size
• Fractured manubrium/sternum – flailFractured manubrium/sternum – flail
• Significant tissue damage at siteSignificant tissue damage at site

4. 4Copyright 2006 - Pyng Medical Corp.
IV FLOW CAPABILITIESIV FLOW CAPABILITIES
• 15-80 ml/min by gravity15-80 ml/min by gravity
• 125 ml/min pressure infusion125 ml/min pressure infusion
• Roughly equivalent to 18g IVRoughly equivalent to 18g IV

5. 5Copyright 2006 - Pyng Medical Corp.
Administering BloodAdministering Blood
• Blood is 4 X more viscous than NSSBlood is 4 X more viscous than NSS
• Result is 1/4 normal rate of flow whenResult is 1/4 normal rate of flow when
administering blood using gravityadministering blood using gravity
• FAST1 system can tolerate increasedFAST1 system can tolerate increased
pressurespressures
• Solution?Solution? USE PRESSURE INFUSIONUSE PRESSURE INFUSION

6. 6Copyright 2006 - Pyng Medical Corp.
Understanding PerpendicularUnderstanding Perpendicular
• FAST1 introducer must be perpendicular toFAST1 introducer must be perpendicular to
the surface of the manubriumthe surface of the manubrium
• 10 circumferential needles penetrate to the10 circumferential needles penetrate to the
bony surface of the manubrium and assurebony surface of the manubrium and assure
uniform, level approachuniform, level approach
• Central trocar goes 6 mm beyondCentral trocar goes 6 mm beyond
circumferential needles and prevents over-circumferential needles and prevents over-
penetrationpenetration
• Rich vasculature drains manubrium… FAST1 isRich vasculature drains manubrium… FAST1 is
equivalent to a central lineequivalent to a central line

7. 7Copyright 2006 - Pyng Medical Corp.
Understanding PerpendicularUnderstanding Perpendicular
• Manubrium is upperManubrium is upper
aspect of sternalaspect of sternal
structurestructure
• Articulates withArticulates with
body of sternum atbody of sternum at
the Angle of Louisthe Angle of Louis

8. 8Copyright 2006 - Pyng Medical Corp.
Understanding PerpendicularUnderstanding Perpendicular
• Note that thereNote that there
are three planesare three planes
relative to therelative to the
patientpatient
– Surface of groundSurface of ground
– Surface of body ofSurface of body of
the sternumthe sternum
– Surface of theSurface of the
manubriummanubrium

9. 9Copyright 2006 - Pyng Medical Corp.
Understanding PerpendicularUnderstanding Perpendicular
• Manubrium surfaceManubrium surface
angle is your pointangle is your point
of focusof focus
• Perpendicular meansPerpendicular means
at right angles toat right angles to
the surface of thethe surface of the
manubriummanubrium

10. 10Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Prepare IV setPrepare IV set
• BSI precautionsBSI precautions
– Gloves minimumGloves minimum
• Prepare site usingPrepare site using
aseptic techniqueaseptic technique

11. 11Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Finger atFinger at
suprasternalsuprasternal
notchnotch
• Patch indentationPatch indentation
abuts fingerabuts finger
• Place patchPlace patch
• Make sure patchMake sure patch
is midlineis midline

12. 12Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Place introducerPlace introducer
needle cluster in holeneedle cluster in hole
on target patchon target patch
• Assure firm gripAssure firm grip
• Keep introducer deviceKeep introducer device
perpendicular to theperpendicular to the
surface of thesurface of the
manubriummanubrium

13. 13Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Insert using increasingInsert using increasing
pressure till devicepressure till device
releases…avoidreleases…avoid
“poking” or “punching”“poking” or “punching”
action when insertingaction when inserting
• PERPENDICULARPERPENDICULAR
ALIGNMENT TO THEALIGNMENT TO THE
MANUBRIUMMANUBRIUM
THROUGHOUTTHROUGHOUT

14. 14Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Following deviceFollowing device
release, Removerelease, Remove
introducer byintroducer by
PULLINGPULLING
STRAIGHT BACKSTRAIGHT BACK
• Use orange sharpsUse orange sharps
cap to covercap to cover
exposed needlesexposed needles

15. 15Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Connect infusionConnect infusion
catheter to tube oncatheter to tube on
the target patchthe target patch

16. 16Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Remove white capRemove white cap
from Luer fittingfrom Luer fitting
• Connect IV lineConnect IV line
• Flush line usingFlush line using
either syringe or byeither syringe or by
bolus from IV bagbolus from IV bag

17. 17Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Cover site withCover site with
protective dome…protective dome…
leave removalleave removal
device attacheddevice attached

18. 18Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Open IV and assureOpen IV and assure
good flow or ingood flow or in
cardiac arrest,cardiac arrest,
inject epinephrineinject epinephrine
directly into Luerdirectly into Luer
fittingfitting
• Observe forObserve for
infiltration or noinfiltration or no
flowflow

19. 19Copyright 2006 - Pyng Medical Corp.
INSERTIONINSERTION
• Problems:Problems:
– InfiltrationInfiltration
• Usually due to insertion not perpendicularUsually due to insertion not perpendicular
to manubriumto manubrium
– Inadequate flow or no flowInadequate flow or no flow
• Infusion tube occludedInfusion tube occluded
– Repeat flushRepeat flush
• Infusion catheter inserted at other thanInfusion catheter inserted at other than
a perpendicular angle to the manubriuma perpendicular angle to the manubrium
surfacesurface