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Cicolini G, Comparcini D, Simonetti V, Maria Papappicco CA, Unsworth J, Tomietto M. Nurses' knowledge and self-assessment of their clinical experiences of intraosseous access: A multicentre cross-sectional study. Int Emerg Nurs 2023; 69:101314. [PMID: 37352644 DOI: 10.1016/j.ienj.2023.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 05/01/2023] [Accepted: 05/25/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Intraosseous access is an effective and safe option when difficult vascular access occurs. The knowledge, competence, and clinical experience of nurses are collectively essential for the successful implementation of this approach in clinical practice. Education and clinical learning are the main pillars supporting this new practice to ensure patient safety. The aim of this study was to identify the nurses' knowledge and clinical experience of intraosseous access and the factors associated with the adoption of this procedure. METHODS A cross-sectional study was carried out from October to December 2020. A convenience sample of 432 nurses from four Italian hospitals were involved. A structured questionnaire was used to assess the nurses' knowledge of the intraosseous access guidelines and their clinical experience. RESULTS Most participants were female (71.5%) with more than 10 years of experience (63.7%) working in an emergency (38.9%) and medical (37.7%) setting. Most of the participants demonstrated their knowledge of the use of a device e.g., it is used if vascular access is not rapidly achieved in a child (83.1%) and the boluses of liquids required in the intraosseous procedure (72.7%). A few participants reported having placed intraosseous access (3.5%). A higher level of educational preparation and working in emergency and paediatric settings were associated with increased knowledge. CONCLUSIONS Our findings highlighted a sub-optimal level of knowledge of the IO procedure, little experience of this practice in clinical contexts, also associated with a lack of adequate protocols and devices available to nurses. Nurses need to develop their knowledge and practice the skill clinically to embed this practice. University and nurse educators should emphasise the relevance of this practice in nursing education and training, so as to improve the nursing care practice and level of patient safety.
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Affiliation(s)
- Giancarlo Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
| | - Dania Comparcini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
| | | | | | - John Unsworth
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Marco Tomietto
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; Visiting Professor, University of Bari "Aldo Moro", Bari, Italy.
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Wang D, Deng L, Zhang R, Zhou Y, Zeng J, Jiang H. Efficacy of intraosseous access for trauma resuscitation: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:17. [PMID: 36918947 PMCID: PMC10012735 DOI: 10.1186/s13017-023-00487-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND During medical emergencies, intraosseous (IO) access and intravenous (IV) access are methods of administering therapies and medications to patients. Treating patients in emergency medical situations is a highly time sensitive practice; however, research into the optimal access method is limited and existing systematic reviews have only considered out-of-hospital cardiac arrest (OHCA) patients. We focused on severe trauma patients and conducted a systematic review to evaluate the efficacy and efficiency of intraosseous (IO) access compared to intravenous (IV) access for trauma resuscitation in prehospital care. MATERIALS AND METHOD PubMed, Web of Science, Cochrane Library, EMBASE, ScienceDirect, banque de données en santé publique and CNKI databases were searched for articles published between January 1, 2000, and January 31, 2023. Adult trauma patients were included, regardless of race, nationality, and region. OHCA patients and other types of patients were excluded. The experimental and control groups received IO and IV access, respectively, in the pre-hospital and emergency departments for salvage. The primary outcome was success rate on first attempt, which was defined as secure needle position in the marrow cavity or a peripheral vein, with normal fluid flow. Secondary outcomes included mean time to resuscitation, mean procedure time, and complications. RESULTS Three reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies; meta-analyses were then performed using Review Manager (Version 5.4; Cochrane, Oxford, UK). The success rate on first attempt was significant higher for IO access than for IV access (RR = 1.46, 95% CI [1.16, 1.85], P = 0.001). The mean procedure time was significantly reduced (MD = - 5.67, 95% CI [- 9.26, - 2.07], P = 0.002). There was no significant difference in mean time to resuscitation (MD = - 1.00, 95% CI [- 3.18, 1.17], P = 0.37) and complications (RR = 1.22, 95% CI [0.14, 10.62], P = 0.86) between the IO and IV groups. CONCLUSION The success rate on first attempt of IO access was much higher than that of IV access for trauma patients, and the mean procedure time of IO access was significantly less when compared to IV access. Therefore, IO access should be suggested as an urgent vascular access for hypotensive trauma patients, especially those who are under severe shock.
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Affiliation(s)
- Dong Wang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Lei Deng
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.,Sichuan Province Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Ruipeng Zhang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Yiyue Zhou
- Department of Biology, Sorbonne University, 75005, Paris, France
| | - Jun Zeng
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.,Sichuan Province Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China. .,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China. .,Sichuan Province Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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3
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Attitudes towards the Utilization of Intraosseous Access in Prehospital and Emergency Medicine Nursing Personnel. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081086. [PMID: 36013553 PMCID: PMC9413818 DOI: 10.3390/medicina58081086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Insertion of an intraosseous access device enables intravascular access for critically ill patients in a prehospital and emergency department setting even when intravenous access is not possible. The aim of our study was to assess the attitudes of prehospital and emergency department nursing staff towards the utilization of intraosseous access devices. Materials and Methods: We performed quantitative research using a closed-ended structured questionnaire distributed to prehospital unit and associated emergency department nursing staff serving a population of around 200,000 inhabitants. Results: We distributed 140 questionnaires, and 106 were returned and completed. Of these, 69 (65.1%) respondents needed more than three attempts to achieve peripheral intravenous access at least once in the last year and 29 (27.4%) required central venous access because of impossible intravenous access. In the last five years, 8 (7.5%) respondents used endotracheal route for administration of medications. Despite this, only 48 (45.3%) of respondents have ever used the intraosseous route. Also, 79 (74.5%) respondents received at least some training in obtaining IO access; however, 46 (43.4%) answered that education regarding intraosseous access is not sufficient, and 92 (86.8%) answered that they wanted additional training regarding intraosseous access. Conclusions: Prehospital and emergency department nursing staff are aware of the importance of intraosseous access and understand the need for additional education and certification in this field.
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Mason MF, Wallis M, Lord B, Barr N. Prehospital use of peripheral intravenous catheters and intraosseous devices: An integrative literature review of current practices and issues. Australas Emerg Care 2020; 23:196-202. [PMID: 32636164 DOI: 10.1016/j.auec.2020.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Peripheral intravenous catheters and intraosseous devices have been widely used in the prehospital setting for a considerable period. Changes in technology and guidelines have led to an increase in situations where use of these devices in a prehospital setting is recommended. Despite being commonplace they are not without risk of harm to the patient. STUDY OBJECTIVE To examine critically the research-based literature related to incidence of insertion of peripheral intravenous catheters and intraosseous devices, the use of these vascular access devices and to determine which health professionals insert them, most commonly, in the prehospital setting. METHODS An integrative review was undertaken using material retrieved following a systematic search of research literature databases, grey literature and secondary sources written in English. No date limit was applied to the search and the searching was undertaken until September 2019. Articles specifically addressing peripheral intravenous catheter and intraosseous device use in the prehospital setting were selected. RESULTS The search resulted in 20 articles being included in the review, 17 related to peripheral intravenous catheters and three for intraosseous devices. All articles related to observational studies across a variety of services and settings. CONCLUSION The role of vascular access in the prehospital setting continues to be significant, particularly for patients who are critically unwell. This review identified that differences in service structure, geography and the patient's condition all impact on the insertion and use of these vascular access devices. Despite this there are limited data reported that can allow prehospital clinicians and services to benchmark their practice.
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Affiliation(s)
- Matthew F Mason
- School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
| | - Marianne Wallis
- School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
| | - Bill Lord
- Department of Community Emergency Health and Paramedic Practice, Monash University, Australia.
| | - Nigel Barr
- School of Nursing Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
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A Video-Based, Case-Control Study of Factors Associated With Intraosseous Catheterization During Pediatric Resuscitation. Ann Emerg Med 2020; 75:755-761. [DOI: 10.1016/j.annemergmed.2019.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022]
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Farrokh S, Cho SM, Lefebvre AT, Zink EK, Schiavi A, Puttgen HA. Use of intraosseous hypertonic saline in critically ill patients. J Vasc Access 2018; 20:427-432. [PMID: 30328363 DOI: 10.1177/1129729818805958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Rapid administration of hypertonic saline 23.4% is crucial in treatment of herniation syndromes. Hypertonic 23.4% saline must be administered via a central line. In cases where central line access is difficult to obtain and leads to delay in therapy, placement of intraosseous access can be lifesaving. MAIN BODY The purpose of this case series is to describe the use of intraosseous administration of 23.4% saline in critically ill patients and to assess feasibility. CONCLUSION Intraosseous administration of 23.4% saline in 6 adult patients with neurological emergencies was feasible and should be considered in cases where obtaining intravenous access is time consuming.
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Affiliation(s)
- Salia Farrokh
- 1 Neuroscience Critical Care Unit, Department of Pharmacy, Critical Care and Surgery Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sung-Min Cho
- 2 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Austen T Lefebvre
- 2 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elizabeth K Zink
- 2 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam Schiavi
- 2 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.,3 Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hans A Puttgen
- 2 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.,3 Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
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Engels PT, Erdogan M, Widder SL, Butler MB, Kureshi N, Martin K, Green RS. Use of intraosseous devices in trauma: a survey of trauma practitioners in Canada, Australia and New Zealand. Can J Surg 2016; 59:374-382. [PMID: 27669404 PMCID: PMC5125919 DOI: 10.1503/cjs.011215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 06/20/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although used primarily in the pediatric population for decades, the use of intraosseous (IO) devices in the resuscitation of severely injured adult trauma patients has recently become more commonplace. The objective of this study was to determine the experience level, beliefs and attitudes of trauma practitioners in Canada, Australia and New Zealand regarding the use of IO devices in adult trauma patients. METHODS We administered a web-based survey to all members of 4 national trauma and emergency medicine organizations in Canada, Australia and New Zealand. Survey responses were analyzed using descriptive statistics, univariate comparisons and a proportional odds model. RESULTS Overall, 425 of 1771 members completed the survey, with 375 being trauma practitioners. IO devices were available to 97% (353 of 363), with EZ-IO being the most common. Nearly all physicians (98%, 357 of 366) had previous training with IO devices, and 85% (223 of 261) had previously used an IO device in adult trauma patients. Most respondents (79%, 285 of 361) were very comfortable placing an IO catheter in the proximal tibia. Most physicians would always or often use an IO catheter in a patient without intravenous access undergoing CPR for traumatic cardiac arrest (84%, 274 of 326) or in a hypotensive patient (without peripheral intravenous access) after 2 attempts or 90 s of trying to establish vascular access (81%, 264 of 326). CONCLUSION Intraosseous devices are readily available to trauma practitioners in Canada, Australia and New Zealand, and most physicians are trained in device placement. Most physicians surveyed felt comfortable using an IO device in resuscitation of adult trauma patients and would do so for indications broader than current guidelines.
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Affiliation(s)
- Paul T. Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); Trauma Nova Scotia, Halifax, NS (Erdogan, Green); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS (Butler, Kureshi, Green); and the Alfred Hospital, Melbourne, Australia (Martin)
| | - Mete Erdogan
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); Trauma Nova Scotia, Halifax, NS (Erdogan, Green); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS (Butler, Kureshi, Green); and the Alfred Hospital, Melbourne, Australia (Martin)
| | - Sandy L. Widder
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); Trauma Nova Scotia, Halifax, NS (Erdogan, Green); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS (Butler, Kureshi, Green); and the Alfred Hospital, Melbourne, Australia (Martin)
| | - Michael B. Butler
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); Trauma Nova Scotia, Halifax, NS (Erdogan, Green); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS (Butler, Kureshi, Green); and the Alfred Hospital, Melbourne, Australia (Martin)
| | - Nelofar Kureshi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); Trauma Nova Scotia, Halifax, NS (Erdogan, Green); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS (Butler, Kureshi, Green); and the Alfred Hospital, Melbourne, Australia (Martin)
| | - Kate Martin
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); Trauma Nova Scotia, Halifax, NS (Erdogan, Green); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS (Butler, Kureshi, Green); and the Alfred Hospital, Melbourne, Australia (Martin)
| | - Robert S. Green
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); Trauma Nova Scotia, Halifax, NS (Erdogan, Green); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Critical Care Medicine, Dalhousie University, Halifax, NS (Butler, Kureshi, Green); and the Alfred Hospital, Melbourne, Australia (Martin)
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Petitpas F, Guenezan J, Vendeuvre T, Scepi M, Oriot D, Mimoz O. Use of intra-osseous access in adults: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:102. [PMID: 27075364 PMCID: PMC4831096 DOI: 10.1186/s13054-016-1277-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022]
Abstract
Background Indications for intra-osseous (IO) infusion are increasing in adults requiring administration of fluids and medications during initial resuscitation. However, this route is rarely used nowadays due to a lack of knowlegde and training. We reviewed the current evidence for its use in adults requiring resuscitative procedures, the contraindications of the technique, and modalities for catheter implementation and skill acquisition. Methods A PubMed search for all articles published up to December 2015 was performed by using the terms “Intra-osseous” AND “Adult”. Additional articles were included by using the “related citations” feature of PubMed or checking references of selected articles. Editorials, comments and case reports were excluded. Abstracts of all the articles that the search yielded were independently screened for eligibility by two authors and included in the analysis after mutual consensus. In total, 84 full-text articles were reviewed and 49 of these were useful for answering the following question “when, how, and for which population should an IO infusion be used in adults” were selected to prepare independent drafts. Once this step had been completed, all authors met, reviewed the drafts together, resolved disagreements by consensus with all the authors, and decided on the final version. Results IO infusion should be implemented in all critical situations when peripheral venous access is not easily obtainable. Contraindications are few and complications are uncommon, most of the time bound to prolonged use. The IO infusion allows for blood sampling and administration of virtually all types of fluids and medications including vasopressors, with a bioavailability close to the intravenous route. Unfortunately, IO infusion remains underused in adults even though learning the technique is rapid and easy. Conclusions Indications for IO infusion use in adults requiring urgent parenteral access and having difficult intravenous access are increasing. Physicians working in emergency departments or intensive care units should learn the procedures for catheter insertion and maintenance, the contraindications of the technique, and the possibilities this access offers. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1277-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Petitpas
- Department of Anesthesiology and Intensive Care, University Hospital of Poitiers, 86021 Poitiers, France.,Laboratory of Anatomy, Biomechanics and Simulation, University Hospital of Poitiers, 86021, Poitiers, France
| | - J Guenezan
- Emergency Department, University Hospital of Poitiers, 86021 Poitiers, France.
| | - T Vendeuvre
- Orthopedic Surgical Department, University Hospital of Poitiers, 86021, Poitiers, France
| | - M Scepi
- Laboratory of Anatomy, Biomechanics and Simulation, University Hospital of Poitiers, 86021, Poitiers, France.,Emergency Department, University Hospital of Poitiers, 86021 Poitiers, France
| | - D Oriot
- Laboratory of Anatomy, Biomechanics and Simulation, University Hospital of Poitiers, 86021, Poitiers, France.,Pediatric Emergency Department, University Hospital of Poitiers, 86021, Poitiers, France
| | - O Mimoz
- Department of Anesthesiology and Intensive Care, University Hospital of Poitiers, 86021 Poitiers, France.,Emergency Department, University Hospital of Poitiers, 86021 Poitiers, France
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James Cheung W, Rosenberg H, Vaillancourt C. Barriers and facilitators to intraosseous access in adult resuscitations when peripheral intravenous access is not achievable. Acad Emerg Med 2014; 21:250-6. [PMID: 24628749 DOI: 10.1111/acem.12329] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/22/2013] [Accepted: 10/07/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Studies suggest that intraosseous (IO) access is underutilized in adult resuscitations, despite recommendations from advanced trauma and cardiac life support guidelines. The objective was to determine factors associated with IO access use by physicians during adult resuscitations when intravenous (IV) access is not immediately achievable. METHODS This study was an online survey among physicians purposefully recruited from various clinical care areas at three teaching hospitals. Questions were generated from the qualitative results of 20 iterative interviews, verified for internal validity, and piloted. The interview guide was based on the constructs of the Theory of Planned Behavior (TPB), which elicits salient attitudes, social influences, and control beliefs that potentially influence intention to use IO access. Recruitment took place in September 2012 until reaching more than 100% of the required sample size (n = 200). Internal consistency was measured using Cronbach's alpha, and the effect of TPB constructs and specific beliefs were assessed with regression analyses. RESULTS For the 205 respondents, the mean age was 35 years (range = 20 to 66 years), and 53.3% were male. Participants' departmental affiliations were 50.3% emergency medicine (EM), 16.9% internal medicine, 14.9% anesthesia, 10.8% general surgery, and 7.2% critical care. Residents comprised 60.7% of the sample, and 39.3% were attending physicians. Median intention to use IO access when IV is not immediately achievable was 4.67 (interquartile range [IQR] = 4 to 5) out of 5 (5 highest) and predicted by the following TPB constructs: attitudes (AdjCoefficients = 0.504; 95% confidence interval [CI] = 0.334 to 0.673), social influences (AdjCoefficients = 0.285; 95% CI = 0.172 to 0.398), and control beliefs (AdjCoefficients 0.217; 95% CI = 0.113 to 0.320). Physicians were more likely to use IO access if they believed that it provided rapid vascular access for delivering large volumes of fluids, could prevent delays in care, and was associated with a low complication rate. Conversely, the perception that nurses are not familiar or supportive of IO access and a lack of physician confidence regarding the appropriate indications for IO access were barriers to use. CONCLUSIONS These data are an important step in the knowledge-to-action process, as they identify specific factors associated with physician use of IO access. Interventions addressing these actionable facilitators and barriers are likely to have a positive effect on increasing the appropriate physician use of this potentially life-saving technique in adult patients requiring emergent vascular access.
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Affiliation(s)
| | - Hans Rosenberg
- The Department of Emergency Medicine; University of Ottawa; Ottawa Ontario
| | - Christian Vaillancourt
- The Department of Emergency Medicine; University of Ottawa; Ottawa Ontario
- The Clinical Epidemiology Program; Ottawa Hospital Research Institute; University of Ottawa; Ottawa Ontario Canada
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