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

Abstract

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.

Construction of an index system of the biosafety incident response capability for nursing staff: A Delphi study

“…As a front-line clinical force, nursing staff are the ones who have the closest contact with patients, and facing the huge biosafety threat. The risk of occupational exposure of nursing staff is greatly increased [41] . Good occupational protection can effectively control occupational risk factors and effectively avoid nursing occupational risks [42] .…”

The relationship between components of the biosafety incident response competence for clinical nursing staff: a network analysis

“…When it comes to handling signi cant new outbreaks of infectious diseases, pathogenic microorganisms, biological weapons, bioterrorist attacks, and other biosafety incidents [8,9], nurses' comprehensive coping abilities-such as preparation, evaluation, early warning, disposal, protection, and rescue-combine to form the nursing staff's ability to deal with biosafety incidents. It can treat infected patients and stop the spread of biosafety infections [10]. What's more, it can reduce the effects of biological hazards, including illness, death, nancial loss, and social unrest, etc.…”

Intraosseous infusion of drugs and fluids in critical patients: a systematic review

“…Existe evidencia de la utilidad del AIO en situaciones especiales en las que los profesionales sanitarios deban llevar equipos de protección químicos, biológicos, radiológicos o nucleares, con los cuales conseguir un AIO puede resultar aún más difícil 18 . La vía intraósea se puede canalizar de forma rápida utilizando estos EPIs y permite la administración temprana de fármacos 19,20 .…”