1
|
Manshadi K, Chang TP, Schmidt A, Lau J, Rake A, Pham P, Illingworth K, Song JL. Validation of a 3-Dimensional-Printed Infant Tibia for Intraosseous Needle Insertion Training. Simul Healthc 2024; 19:56-63. [PMID: 36194860 DOI: 10.1097/sih.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Current bone models used for pediatric intraosseous (IO) placement training are expensive or lack anatomic and/or functional fidelity. This technical report describes the development and validation of a 3-dimensional printed (3DP) tibia from a pediatric lower extremity computed tomography scan for IO procedural training. METHODS Multiple 3DP tibia models were printed using a dual-extrusion fused-filament fabrication printer. Models underwent iterative optimization until 2 final models, one of polypropylene (3DP clear) and the other of polylactic acid/polypropylene (3DP white), were selected. Using an exploratory sequential mixed-methods design, a novel IO bone model assessment tool was generated. Physicians then used the assessment tool to evaluate and compare common IO bone models to the novel 3DP models during IO needle insertion. RESULTS Thirty physicians evaluated the provided pediatric IO bone models. Compared with a chicken bone as a reference, the 3DP white bone had statistically significantly higher mean scores of anatomy, heft, sense of being anchored in the bone, quality of bone resistance, and "give" when interfaced with an IO needle. Twenty-two of the 30 participants ranked the 3DP white bone as either 1st or 2nd in terms of ranked preference of pediatric IO bone model. A 3DP white bone costs $1.10 to make. CONCLUSIONS The 3DP IO tibia models created from real-life computed tomography images have high degrees of anatomic and functional realism. These IO training models are easily replicable, highly appraised, and can be printed at a fraction of the cost of commercially available plastic models.
Collapse
Affiliation(s)
- Keya Manshadi
- From the Division of Emergency and Transport Medicine (K.M., T.P.C., A.S., P.P., J.L.S.), Division of Anesthesiology Critical Care Medicine (J.L., A.R.), Children's Hospital Los Angeles; Department of Pediatrics (T.P.C., J.L., A.R., K.I., J.L.S.), Keck School of Medicine, University of Southern California; and Children's Orthopedic Center (K.I.), Children's Hospital Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Márquez-Hernández VV, Gutiérrez-Puertas L, García-Viola A, Garrido-Molina JM, Gutiérrez-Puertas V, Aguilera-Manrique G, Rodríguez-García MC. Self-Efficacy in the Cannulation Technique for Intraosseous Access in Pediatric Cardiac Arrest: Egg Versus Bone. Pediatr Emerg Care 2023; 39:940-944. [PMID: 37079583 DOI: 10.1097/pec.0000000000002941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES The use of intraosseous (IO) access is recommended in cardiac arrest when peripheral venous access is not accessible. Various methodologies exist that are used for teaching and learning about cannulation of the IO route both in education and in research. The purpose of the present study was to compare self-efficacy in the cannulation technique for IO access through different techniques. METHODS A randomized comparative study was conducted. A total of 118 nursing students participated. The participants were randomly distributed into 2 intervention groups: chicken bone and egg. A checklist was used for data collection to evaluate the IO cannulation technique in nursing students and another to analyze self-efficacy. RESULTS The average total score of self-efficacy for all participants was 8.84 (standard deviation (SD) = 0.98). No statistically significant differences were found when comparing the total self-efficacy score and the intervention group ( U = 1604.500; z = -0.733; P = 0.463). No statistically significant differences were found between both groups for the average total score of the procedure ( U = 6916.500; z = -0.939; P = 0.348). The egg group carried out the IO cannulation procedure in a significantly less amount of time (M = 126.88, SD = 82.18) than the chicken bone group (M = 183.77, SD = 108.28), finding statistically significant differences ( U = 4983.500; z = -5.326; P < 0.001). CONCLUSIONS Using an egg to teach and learn about IO access could be considered a methodology that is equally effective as using a chicken bone, with the advantage of achieving IO access in a lesser amount of time.
Collapse
Affiliation(s)
| | | | - Alba García-Viola
- Servicio de Urgencias de Atención Primaria de Distrito Sanitario Almería
| | | | | | | | | |
Collapse
|
3
|
Wade RE, McCullum B, Patey C, Dubrowski A. Development and Evaluation of a Three-Dimensional-Printed Pediatric Intraosseous Infusion Simulator To Enhance Medical Training. Cureus 2022; 14:e21080. [PMID: 35165544 PMCID: PMC8826949 DOI: 10.7759/cureus.21080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Vascular access is an essential and rate-limiting step during pediatric resuscitation efforts. Intraosseous (IO) access, an effective resuscitative strategy, remains underutilized in emergency departments. Many medical graduates report never performing the procedure before graduation, and it has been recommended that continuing education and in-servicing programs be implemented to increase the use and familiarity of IO access. The goal of this technical report is to describe the development and evaluation of a three-dimensional (3D)-printed Pediatric IO Infusion Model for simulation-based medical education. The simulator was designed by combining open-source models of a human skeleton and a lower leg surface scan in Blender (Blender Foundation, Amsterdam, Netherlands; www.blender.org), scaled to a pediatric size, and manipulated further using a JavaScript program. Polylactic acid was used to simulate bone while silicone molds were used as skin and soft tissue. Two trainers were produced and evaluated by seven emergency medicine physicians, two family medicine residents, and three medical students. Overall, the simulator was positively received with all participants indicating they would recommend it to assist in the training of others. Suggestions focused on enhancing the anatomical representations of both the skin and bones to enhance the learner experience. The content and outcomes of this report support the use of this simulator as part of simulation-based medical education.
Collapse
|
4
|
Eifinger F, Scaal M, Wehrle L, Maushake S, Fuchs Z, Koerber F. Finding alternative sites for intraosseous infusions in newborns. Resuscitation 2021; 163:57-63. [PMID: 33862177 DOI: 10.1016/j.resuscitation.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/17/2021] [Accepted: 04/01/2021] [Indexed: 02/04/2023]
Abstract
AIM Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia. METHODS The cadavers used were legal donations. 20 stillborns (mean: 29.2weeks, IQR 27.1-39.6) were investigated. Spectral-CT were analysed to calculate the diameter and circumferences of: i) proximal humerus ii) distal femur iii) proximal tibia iv) diaphyseal tibial. Contrast medium was applied under video documentation to investigate the drainage into the vascular system. RESULTS In term newborns, diameter of the cortex of the proximal humeral head is 12.1 ± 1.8 mm, distal end of the femur 11.9 ± 3.4 mm and the proximal tibial bone 12.0 ± 2.4 mm with cross-sectional diameter of 113.5 ± 19.7 mm2, 120.6 ± 28.2 mm2 and 111.6 ± 29.5 mm2, respectively. Regarding the preterm groups, there is a strong age-related growth in diameter and cross -sectional size. The diaphyseal area is the smallest in all measured bones with an age-dependent increase and is about half of that of metaphyseal diameters (proximal and distal) and about one third of that of metaphyseal cross sectional areas. The proximal femoral head region has the largest diameter of all measured bones with an egg-shaped formation with an extensive joint capsula. All investigated metaphyseal areas lack a clearly enclosed bone marrow cavity. Infusion of contrast medium into the distal femoral end and the proximal humerus head demonstrate the drainage of contrast medium into the central venous system within seconds. CONCLUSION Proximal humeral head and distal femoral end might be alternative IO areas which may lead to further IO puncture sites in neonates.
Collapse
Affiliation(s)
- Frank Eifinger
- Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany.
| | - Martin Scaal
- Institute of Anatomy II, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany
| | - Lukas Wehrle
- Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany
| | - Stien Maushake
- Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany
| | - Zeynep Fuchs
- Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany
| | - Friederike Koerber
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany
| |
Collapse
|
5
|
Abstract
BACKGROUND Obtaining intravascular access can be challenging or even impossible in several clinical situations. As an alternative, medications and fluids can be administered via the intraosseous (IO) route, which is a well-tolerated and established alternative, especially in the emergency setting. METHODS Seventy-five novice physicians participated in this randomized simulation study. After a single educational session and 6 months without any clinical application, participants were asked to identify the correct puncture site and obtain IO access using 3 widely used mechanical devices (BIG Pediatric, Arrow EZ-IO, NIO Pediatric) and a manual device (Jamshidi needle) on a pediatric manikin and turkey bone, respectively. RESULTS Sixty-eight participants correctly identified the puncture site and performed IO cannulations. First placement attempt success rate was similar with mechanical devices (NIO Pediatric, 100%; Arrow EZ-IO, 97%; and BIG Pediatric, 90%), whereas was only 43% using the manual Jamshidi device. Also, procedure time was much faster using mechanical devices (ranging between 18 and 23 seconds) compared with the manual Jamshidi device (34 seconds). CONCLUSIONS Although the efficacy of devices was demonstrated in simulated environment in novice users, further studies are needed to assess the efficacy and safety of devices in clinical comparative settings. With more experienced users, the success rate may differ considerably as compared with naive users.
Collapse
|
6
|
Takahashi S, Ozawa Y, Nagasawa J, Ito Y, Ouchi G, Kabbur P, Moritoki Y, Berg BW. Umbilical catheterization training: Tissue hybrid versus synthetic trainer. Pediatr Int 2019; 61:664-671. [PMID: 31145817 DOI: 10.1111/ped.13904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/22/2018] [Accepted: 02/07/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study of umbilical catheterization deliberate practice training compared skill and knowledge outcomes of umbilical catheterization using a tissue-hybrid simulator (REAL) versus a synthetic simulated umbilical cord task trainer (ART). METHODS This was a prospective randomized control study. Pediatric residents were randomized to REAL or ART umbilical catheterization deliberate practice training. Pre-post-training changes in skill performance and knowledge scores for REAL and ART groups were compared. Fidelity of REAL and ART were compared by neonatologists. RESULTS Twenty-seven pediatric residents completed training. Post-training mean skill scores were improved compared to pre-test scores (REAL, P < 0.001; ART, P < 0.0001). Post-training skill, knowledge, and self-efficacy scores were not different between the REAL and ART groups. Fidelity of REAL was higher than ART for neonatologists (P < 0.01). CONCLUSIONS The face validity of REAL was superior to ART, but resident umbilical cord deliberate practice training demonstrated no difference in skill, knowledge, and self-efficacy improvements between REAL and ART. Further studies on real patients are needed to evaluate the impact of using real or simulated umbilical cords for umbilical venous catheter/umbilical arterial catheter training.
Collapse
Affiliation(s)
- Shigehiro Takahashi
- National Center for Child Health and Development, Tokyo, Japan.,SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Yuri Ozawa
- National Center for Child Health and Development, Tokyo, Japan.,SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Junko Nagasawa
- National Center for Child Health and Development, Tokyo, Japan
| | - Yushi Ito
- National Center for Child Health and Development, Tokyo, Japan
| | - Gen Ouchi
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Prakash Kabbur
- Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, USA.,Medical Center of Arlington, Sheridan Healthcare Services, Arlington, Texas, USA
| | - Yuki Moritoki
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.,Center for Medical Education and Training, Akita University Hospital, Akita, Japan
| | - Benjamin W Berg
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| |
Collapse
|
7
|
Abstract
Intraosseous cannulation is an increasingly common means of achieving vascular access for the administration of fluids and medications during the emergent resuscitation of both paediatric and adult patients. Improved tools and techniques for intraosseous vascular access have recently been developed, enabling the healthcare provider to choose from a wide range of devices and insertion sites. Despite its increasing popularity within the adult population, and decades of use in the paediatric population, questions remain regarding the safety and efficacy of intraosseous infusion. Although various potential complications of intraosseous cannulation have been theorized, few serious complications have been reported. This article aims to provide a review of the current literature on intraosseous vascular access, including discussion on the various intraosseous devices currently available in the market, the advantages and disadvantages of intraosseous access compared to conventional vascular access methods, complications of intraosseous cannulation and current recommendations on the use of this approach.
Collapse
Affiliation(s)
- James H Paxton
- Department of Emergency Medicine, Detroit Medical Center, Detroit, MI, USA
| |
Collapse
|
8
|
Shavit I, Hoffmann Y, Galbraith R, Waisman Y. Comparison of two mechanical intraosseous infusion devices: A pilot, randomized crossover trial. Resuscitation 2009; 80:1029-33. [DOI: 10.1016/j.resuscitation.2009.05.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/15/2009] [Accepted: 05/28/2009] [Indexed: 11/16/2022]
|
9
|
63. INTRAOSSEOUS ACCESS DEVICES. JOURNAL OF INFUSION NURSING 2006. [DOI: 10.1097/00129804-200601001-00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Zink W, Bernhard M, Keul W, Martin E, Völkl A, Gries A. Invasive Techniken in der Notfallmedizin. Anaesthesist 2004; 53:1086-92. [PMID: 15490081 DOI: 10.1007/s00101-004-0762-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Based on written surveys conducted during the series of workshops entitled "Invasive emergency techniques (INTECH)" the aim of this study was to characterize defined qualifications of emergency physicians and to discuss by examples whether strictly practice-oriented workshops represent a suitable means of closing the apparent gaps in training. Our data show clearly that even experienced emergency physicians indicated that they lack training in carrying out preclinical invasive emergency procedures such as chest tube, cricothyrotomy and intraosseous access. Furthermore, they are only very seldom confronted with emergency situations in which these procedures could decidedly affect the survival of a patient and which, at the same time, put them under extremely high emotional pressure. Thus, the didactic concept of continuing education workshops that are strictly practice-oriented and that focus in particular on problem areas in emergency medicine, can contribute significantly to help close the gaps in training and ensure that emergency physicians are highly qualified.
Collapse
Affiliation(s)
- W Zink
- Klinik für Anaesthesiologie, Universitätsklinikum, Heidelberg
| | | | | | | | | | | |
Collapse
|