Rapid vascular glucose uptake via enzyme-assisted subcutaneous infusion: enzyme-assisted subcutaneous infusion access study

Am J Emerg Med. 2009 Nov;27(9):1072-80. doi: 10.1016/j.ajem.2008.08.028.

Abstract

Background: Enzyme-assisted subcutaneous infusion (EASI), with subcutaneous human recombinant hyaluronidase pretreatment, may offer an alternative to standard intravenous (IV) access.

Objectives: This study's objectives were to assess paramedic (Emergency Medical Technician-Paramedic [EMTP])-placed EASI access in volunteers to determine (1) feasibility of EMTP EASI access placement; (2) subject/EMTP ratings of placement ease, discomfort, and overall EASI vs IV preference; and (3) speed of intravascular uptake of EASI infusate.

Methods: Twenty adults underwent 20-gauge IV placement by 4 EMTPs, receiving a 250-mL maximal-rate IV bolus of normal saline. Next, each subject received in the other arm a 20-gauge EASI access line (with 1-mL injection of 150 U of human recombinant hyaluronidase), through which was infused 250 mL D5NS (1 g glucose was labeled with stable tracer 13C). Blood draws enabled gas chromatography/mass spectrometry (GC/MS) assessment of 13C-glucose uptake. Intravenous access and EASI access were compared for time parameters and subject/EMTP ratings. Data were analyzed with median and interquartile range, Kruskal-Wallis testing, Fisher exact test, and regression (GC/MS data).

Results: Intravenous access and EASI access were successful in all 20 subjects. Compared with EASI access (all placed in <15 seconds), IV access took longer; but the 250-mL bolus was given more quickly via IV access. EMTPs rated EASI easier to place than IV; pain ratings were similar for IV and EASI. The GC/MS showed intravascular uptake at all time points.

Conclusions: Enzyme-assisted subcutaneous infusion is faster and easier to initiate than IV access; intravascular absorption of EASI-administered fluids begins within minutes.

Trial registration: ClinicalTrials.gov NCT00386386.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Catheterization, Peripheral / methods*
  • Emergency Medical Services*
  • Feasibility Studies
  • Female
  • Glucose / administration & dosage*
  • Glucose / pharmacokinetics*
  • Humans
  • Hyaluronoglucosaminidase / administration & dosage*
  • Infusions, Subcutaneous
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Recombinant Proteins / administration & dosage*
  • Young Adult

Substances

  • Recombinant Proteins
  • Hyaluronoglucosaminidase
  • Glucose

Associated data

  • ClinicalTrials.gov/NCT00386386