Pediatric Intraosseous Access Performed by Emergency Department Nurses Using Semiautomatic Devices

Feldman, Oren; Nasrallah, Najib; Bitterman, Yuval; Shavit, Roni; Marom, Dana; Rapaport, Zofia; Kabesa, Shauli; Benacon, Michael; Shavit, Itai

doi:10.1097/pec.0000000000001621

Cited by 11 publications

(4 citation statements)

References 24 publications

(53 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…El-Nawawy et al [ 25 ] in a study analysing intravascular access in paediatric septic shock patients indicated that the success rate of the first attempt of IV and intraosseous access was varied and amounted to 50% and 100%, respectively. As implied by Feldman et al [ 26 ], paramedics presented a slightly higher insertion success rates in intraosseous access compared with emergency department nurses in a paediatric bone model (83.3% vs. 79.4%); the effectiveness of obtaining access equalled 80% vs. 70.6% for the NIO-P intraosseous access device and 86.7% vs. 88.2% for EZ-IO. Szarpak et al [ 27 ] observed the effectiveness of NIO-P, EZ-IO, and Jamshidi at the level of 100%, 97%, and 43%, respectively.…”

Section: Discussionmentioning

confidence: 90%

Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation: A randomized crossover simulation trial

Drozd¹,

Smereka

Pruc³

et al. 2021

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

Background Prehospital emergency care of children is challenging. In the era of the COVID-19 pandemic, when medical personnel should use personal protective equipment against aerosol-generating procedures, the efficiency of medical procedures may decrease. The study objective was to evaluate the effectiveness of different intravascular access methods applied by nurses wearing biosafety Level-2 suits in simulated paediatric COVID-19 resuscitation. Methods A prospective, randomized, crossover, single-blinded simulation trial was performed. Nursing staff attending Advanced Cardiovascular Life Support courses accredited by the American Heart Association participated in the study. A total of 65 nurses were recruited and randomly assigned to different study groups. They received standard training on intravascular access methods employing distinct devices. The participants wore biosafety Level-2 suits and performed vascular access with the following intraosseous devices: NIO-P, EZ-IO, and Jamshidi needle; intravenous (IV) access was used as a reference method. Both the order of participants and the access methods were random. Each participant performed intravascular access with each of the four methods tested. The effectiveness of the first attempt to obtain intravascular access and the following time parameters were analysed: the time between grasping the intravascular device out of the original packing until infusion line connection. The ease of the procedure was measured with a visual analogue scale (1 – easy; 10 – difficult). Results The first attempt success rate of intravascular access by using NIO-P and EZ-IO equalled 100% and was statistically significantly higher than that with the Jamshidi needle (80.0%; p = 0.02) and with the IV method (69.2%; p = 0.005). The time required to connect the infusion line varied and amounted to 33 ± 4 s for NIO-P compared to 37 ± 6.7 s for EZ-IO ( p < 0.001 ), 43 ± 7 s for Jamshidi ( p < 0.001 ), and 98.5 ± 10 s for IV access ( p < 0.001 ). The procedure was easiest in the case of NIO-P and EZ-IO (2 ± 1 points; p = 1.0 ) compared with Jamshidi (5 ± 3 points; p < 0.001 ) and IV access (7 ± 2 points; p < 0.001 ). Conclusion The study provides evidence that nurses wearing biosafety Level-2 suits were able to obtain intraosseous access faster and more effectively as compared with IV access during simulated COVID-19 paediatric resuscitation. The most effective method of intravascular access was the NIO-P intraosseous device. Further clinical trials are necessary to confirm the results.

show abstract

Section: Discussionmentioning

confidence: 90%

Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation: A randomized crossover simulation trial

Drozd¹,

Smereka

Pruc³

et al. 2021

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Gaining vascular access is of critical importance in resuscitative, therapeutic, and diagnostic measures [ 8 , 9 ]. IO cannulation is the first-line alternative technique in gaining vascular access in critically ill patients when central or peripheral venous access is unattainable in both hospital and pre-hospital conditions.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of this review suggest that IO access should be considered for hypotensive trauma patients, especially those who are under severe hypovolemic shock [ 4 ]. Multiple studies show high success rates by physicians, nurses, and paramedics in performing IO cannulation of adults and pediatric patients [ 7 , 8 ]. In fact, studies have shown there is no statistically significant difference in complications between the IO and IV interventions [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Compartment Syndrome Resulting From Improper Intraosseous Cannulation: A Case Report

Desai,

Mann,

Azar

et al. 2023

Cureus

View full text Add to dashboard Cite

Obtaining adequate vascular access is imperative for effective resuscitative, therapeutic, and diagnostic interventions. The intraosseous (IO) route is indicated when immediate vascular access is needed, and standard central or peripheral intravenous (IV) access is unattainable or would delay therapy in a critical patient. We present a rare case of improper IO line placement in the right proximal tibia of a 30-year-old female involved in a motor vehicle collision, resulting in extravasation of blood products into the surrounding tissue and development of acute compartment syndrome. Emergency Medical Services was unable to obtain IV access in a timely manner, thus a right proximal tibia 45mm IO line was placed, and a unit of whole blood was given with a high-pressure infusor in the field. At the trauma center, the patient’s right lower extremity was severely tense and edematous with no palpable right lower extremity pulses and no Doppler signals. Computed tomography revealed the IO catheter extending through both the proximal and distal cortices of the right tibia. Medial and lateral fasciotomy of the right lower extremity was performed in which all four compartments of the right lower leg were released and a significant hematoma was evacuated from the superficial posterior compartment. This case highlights the importance of IO access as a life-saving intervention while also underscoring the need to educate and familiarize pre-hospital and hospital healthcare personnel in delivering IO access so as to mitigate risks and improve outcomes for critically ill patients.

show abstract

“…Notably, IO access in critical patients with severe hypotension seems to have a higher success rate compared to a traditional venous access; hence, IO access should be considered an alternative priority 2,3 . However, despite the literature underlines that IO access may be easily learnt by the healthcare sta , this procedure is still scarcely used 2,4,5 .…”

Section: Introductionmentioning

confidence: 99%

Intraosseous access: a simulation analysis

Miki¹,

Rinaldi²,

Giorgio³

et al. 2023

View full text Add to dashboard Cite

Introduction: The priority in critical patients is to find a vascular access. The most used access is the peripheral venous access, but when its placement goes wrong or is difficult, the literature recommends implementing intraosseous (IO) access as a valid alternative. The IO access is a rapid, reliable and a relatively safe method. Despite the recommendations, IO access is rarely used when indicated. The objective of this study was to evaluate the critical points of the IO procedure, positioning time, percentage of success at first attempt in simulation and, in according to obtained outcomes, checking of the procedure inclusion within university programs. Material and methods: A sample of 84 people was recruited; among them 44 were students attending the third year of the Degree Course in Nursing of the University of Turin (site of Asti) and 40 nurses from intensive care unit and emergency ward of Cardinal Massaia Hospital of Asti. A short lesson about IO access took place, followed by a practical demonstration. Subsequently, the IO access insertion performance and difficulty perceived were evaluated. Statistical analysis was performed by means of inferential and descriptive bivariate analysis. Results: The average value of the performance “IO access insertion” was 12.2±1.22 (average of the assigned points by the sample). The average difficulty perceived was 1.65±0.42, and mainly found in “selection of the correct point of insertion” with a value of 2.64±0.87, “needle placement” with a medium value of 2.35±1.02 and “medication” with a value of 2.0±0.94. Average execution time of IO access and needle placement were 73.3 and 36.1 seconds, respectively. Finally, the success rate at the first attempt was 72.6%. Discussion: The IO access execution time, for the complete procedure and for the needle placement only, was below the 3 minutes. Among nurses and students, data of the success of the procedure show significant results, but the difference between subgroups is still lower than expected considering the results of the statistical analysis about procedure success, execution time and error percentage. Most critical issues were found in the retrieval of area of insertion, whereas the most difficulty perceived was on reference point selection, correct needle placement and medication. The procedure may become subject of teaching in the University. Conclusion: The study evaluates the possibility of the IO access use, by underlining how is necessary a training about it. The principal reason of ‘non-use’ of this device is the disinformation of healthcare professionals. The results seem to underline the importance of a possible integration of IO access technique in the programs of Degree Nursing Course and post-base course. This may improve nursing in emergency situations and therefore, patient outcomes. When healthcare staff training is possible, periodical refresh is particularly recommended in order to maintain the acquired skills.

show abstract

Pediatric Intraosseous Access Performed by Emergency Department Nurses Using Semiautomatic Devices

Cited by 11 publications

References 24 publications

Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation: A randomized crossover simulation trial

Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation: A randomized crossover simulation trial

Compartment Syndrome Resulting From Improper Intraosseous Cannulation: A Case Report

Intraosseous access: a simulation analysis

Contact Info

Product

Resources

About