Hacking Intraosseous Infusion Skills Training With 3D Printing: maxSIMIO Drilling System

Abstract

Intraosseous (IO) infusion is an alternative way to access the vascular system to administer drugs and fluids, which is particularly helpful when the commonly used peripheral intravenous route is inaccessible. The IO procedure can be done using a drill that involves disinfecting the area, landmarking the insertion point, seating the needle in a firm and stable position in the bone, and then delivering a smooth fluid flush. However, in the current medical training landscape, access to commercially available IO drills such as the Arrow® EZ-IO® Power Driver (EZ-IO; Teleflex, Morrisville, North Carolina, United States) is difficult, especially for rural and remote areas, due to the high costs. Furthermore, the EZ-IO is not rechargeable and does not clearly indicate the remaining battery life, which could potentially put patients at risk during the IO procedure. This technical report aims to address these concerns by describing the development of an alternative, affordable, and reliable IO drilling system for training use: the maxSIMIO Drilling System. This system consists of a cordless and rechargeable IKEA screwdriver which connects to a conventional, hexagon-shaped 3D-printed drill bit needle adapter. Two needle adapters were created: Version A was designed to use a friction-based mechanism to couple the screwdriver with the EZ-IO training needle, while Version B relies on a magnetic mechanism. The major differences between the EZ-IO and the screwdriver are that a) the EZ-IO has only one rotation to advance the cannula while the screwdriver features both directions, b) the EZ-IO is not rechargeable while the screwdriver is, and c) the EZ-IO has a custom needle holder that can fit any EZ-IO training needle size while the screwdriver needs to have a custom needle adapter made to connect to the EZ-IO training needle. Overall, through this exploration, the features of the maxSIMIO Drilling System in comparison to the EZ-IO appear more accessible for IO training. Future considerations for this development include gathering clinical expertise through rigorous testing of this novel system.

The Perceived Effectiveness of Various Forms of Feedback on the Acquisition of Technical Skills by Advanced Learners in Simulation-Based Health Professions Education

“…The overarching aim of this work was to answer the question of what type of feedback (KR, KP, intrinsic) is perceived to be most effective when acquiring complex technical skills by advanced learners in the context of SBHPE of learning IO access skills by ACPs. To accomplish this, we first had to operationally define two types of augmented feedback (KP and KR) in this context which was described in the companion paper [ 6 ]. In this article, we describe the second phase of this work where ACPs from the Region of Durham Paramedic Services used an IO access simulator and received all three forms of feedback (KP, KR, and intrinsic) from paramedic educators.…”

“…In the first phase of this work, the design phase utilized design thinking and Delphi methods to determine what KP and KR can be provided to ACPs concerning the IO access simulator, as described in a previous article [ 6 ]. The second phase, and the focus of this article, was situated within the test and evaluation phases of DBR.…”

“…Thus, before assessing the perceived effectiveness of each of these types of feedback, a prior study was conducted to establish consensus among expert paramedic educators regarding the definitions of two types of augmented feedback (KP and KR) in this specific context. This process described in the companion paper yielded an eight-point feedback list, comprising both KP and KR, which served as a guideline for paramedic facilitators when offering feedback to ACPs using the IO access simulator [ 6 ]. The KP feedback was highly specific, focusing on the correct execution of each step, while KR feedback merely indicated whether the outcome of the step was accurate or not.…”