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Drumheller BC, Edgar MD, Tape MK, Vongviphut D, Herres JP. Comparison of the NIO and EZIO for Resuscitative Vascular Access in the Emergency Department: A Quasi-Experimental, Before-and-After Study. Mil Med 2023; 188:3423-3431. [PMID: 35870113 DOI: 10.1093/milmed/usac126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION Intraosseous (IO) needle insertion is a key adjunctive procedure in the care of critically ill and injured patients in a variety of settings, including the battlefield. The NIO is a new, fully disposable, single-piece, IO device with potential practical advantages under austere conditions. We sought to compare the efficacy and safety of the NIO to an established, well-studied device, the EZIO, when used for resuscitative vascular access in the emergency department (ED). METHODS Retrospective, single-center, quasi-experimental, before-and-after, observational cohort study performed at an urban, tertiary-care hospital ED among adult patients receiving IO access during resuscitation. The before/NIO period lasted from July 1, 2019, to May 31, 2020, and the EZIO/after period from June 1, 2020, to April 30, 2021. Patient demographics, prehospital treatment, ED presentation, characteristics and results of IO insertion(s), potential procedure-associated adverse events, and ED and hospital outcomes were abstracted from the medical record. The primary outcome, rate of first-pass success (FPS), was compared between the NIO and EZIO periods using multivariable regression after adjustment for potential confounding factors. RESULTS We enrolled 63 total patients/66 limbs (mean age 61 ± 18, 51% female), 34 patients/35 limbs during the NIO period and 29 patients/31 limbs during the EZIO period. The most common reason for IO insertion was cardiac arrest (40/63, 63%), followed by respiratory failure, trauma, and sepsis. The majority of IO insertions were performed at the proximal tibia (58/66, 88%) by senior emergency medicine residents or faculty. The overall rate of FPS was 53/66 (80%), 24/35 (69%) with the NIO compared to 29/31 (94%) with the EZIO. After multivariable modeling, the odds of FPS with the NIO vs. the EZIO was 0.19 (95% CI, 0.01-1.5, P = .16). Procedure-related adverse events were infrequent in both groups. In-hospital mortality was 45/63 (71%). CONCLUSIONS We found that the NIO device was associated with a lower-than-expected rate of FPS compared to the EZIO device, although not significantly different after adjusting for between-group imbalances and considering limitations in the study design. Further, prospective research into the efficacy and safety of the NIO is needed before clinical use can be encouraged.
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Affiliation(s)
- Byron C Drumheller
- Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, USA
| | - Matthew D Edgar
- Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, USA
| | - Meghan K Tape
- Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, USA
| | - Don Vongviphut
- Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, USA
| | - Joseph P Herres
- Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, USA
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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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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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Awareness, current use and attitudes toward intraosseous access among physicians and nurses in China: a national web-based survey. Eur J Emerg Med 2022; 29:78-79. [PMID: 34932033 DOI: 10.1097/mej.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eagles D, Cheung WJ, Avlijas T, Yadav K, Ohle R, Taljaard M, Molnar F, Stiell IG. Barriers and facilitators to nursing delirium screening in older emergency patients: a qualitative study using the theoretical domains framework. Age Ageing 2022; 51:6509750. [PMID: 35061872 DOI: 10.1093/ageing/afab256] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND delirium is common in older emergency department (ED) patients, but vastly under-recognised, in part due to lack of standardised screening processes. Understanding local context and barriers to delirium screening are integral for successful implementation of a delirium screening protocol. OBJECTIVES we sought to identify barriers and facilitators to delirium screening by nurses in older ED patients. METHODS we conducted 15 semi-structured, face-to-face interviews based on the Theoretical Domains Framework with bedside nurses, nurse educators and managers at two academic EDs in 2017. Two research assistants independently coded transcripts. Relevant domains and themes were identified. RESULTS a total of 717 utterances were coded into 14 domains. Three dominant themes emerged: (i) lack of clinical prioritisation because of competing demands, lack of time and heavy workload; (ii) discordance between perceived capabilities and knowledge and (iii) hospital culture. CONCLUSION this qualitative study explored nursing barriers and facilitators to delirium screening in older ED patients. We found that delirium was recognised as an important clinical problem; however, it was not clinically prioritised; there was a false self-perception of knowledge and ability to recognise delirium and hospital culture was a strong influencer of behaviour. Successful adoption of a delirium screening protocol will only be realised if these issues are addressed.
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Affiliation(s)
- Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Tanja Avlijas
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Ohle
- Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frank Molnar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
| | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Feldman O, Nasrallah N, Bitterman Y, Shavit R, Marom D, Rapaport Z, Kabesa S, Benacon M, Shavit I. Pediatric Intraosseous Access Performed by Emergency Department Nurses Using Semiautomatic Devices: A Randomized Crossover Simulation Study. Pediatr Emerg Care 2021; 37:442-446. [PMID: 30256319 DOI: 10.1097/pec.0000000000001621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND No study has examined the performance of emergency department (ED) nurses in establishing intraosseous access (IO) access. This study aimed to evaluate ED nurses' success rate in establishing pediatric IO access using semiautomatic devices. METHODS A randomized crossover simulation study was conducted. The success rates of ED nurses were compared with those of paramedics with similar years of experience. The study instruments were the new spring-loaded injector (NIO) and the battery power drill (EZ-IO). Uncooked piglets' bones were used as the study model. All attempts were filmed by a video camera. Successful placement was defined as the visualization of flow from the marrow cavity. Participants recorded their ranking of the "ease of use" of each device. RESULTS No differences in 1-attempt success rate was found between nurses and paramedics (27/34 [79.4%] vs 25/30 [83.3%], P = 0.68). Nurses and paramedics had similar success rates with the 2 semiautomatic IO devices (12/17 vs 12/15 with the spring-loaded injector, P = 0.69, and 15/17 vs 13/15 with the battery power drill, P = 0.9). The number of failed attempts and the causes for failure were equally distributed between nurses and paramedics. Median ease-of-use Likert-scale scores of the spring-loaded injector and the battery power drill were 4 (interquartile range [IQR] = 3-4) and 5 (IQR = 5-5) (P < 0.04) for the nurses and 5 (IQR = 4-5) and 5 (IQR = 4-5) (P = 0.44) for the paramedics, respectively. CONCLUSIONS Emergency department nurses and paramedics had a similarly high insertion success rates on a pediatric bone model. This pilot study suggests that ED nurses can successfully perform this procedure.
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Affiliation(s)
| | | | - Yuval Bitterman
- Pediatric Department, Ruth Children's Hospital, Rambam Health Care Campus, Haifa
| | - Roni Shavit
- Faculty of Life Sciences, Tel Aviv University, Tel Aviv
| | | | - Zofia Rapaport
- Advanced Nursing Education Center, Rambam Health Care Campus, Haifa
| | - Shauli Kabesa
- Advanced Nursing Education Center, Rambam Health Care Campus, Haifa
| | - Michael Benacon
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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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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The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review. J Trauma Acute Care Surg 2019; 84:558-563. [PMID: 29300281 DOI: 10.1097/ta.0000000000001795] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Quick and successful vascular access in injured patients arriving in extremis is crucial to enable early resuscitation and rapid OR transport for definitive repair. We hypothesized that intraosseous (IO) access would be faster and have higher success rates than peripheral intravenous (PIV) or central venous catheters (CVCs). METHODS High-definition video recordings of resuscitations for all patients undergoing emergency department thoracotomy from April 2016 to July 2017 were reviewed as part of a quality improvement initiative. Demographics, mechanism of injury, access type, access location, start and stop time, and success of each vascular access attempt were recorded. Times to completion for access types (PIV, IO, CVC) were compared using Kruskal-Wallis test adjusted for multiple comparisons, while categorical outcomes, such as success rates by access type, were compared using χ test or Fisher's exact test. RESULTS Study patients had a median age of 30 years (interquartile range [IQR], 25-38 years), 92% were male, 92% were African American, and 93% sustained penetrating trauma. A total of 145 access attempts in 38 patients occurred (median, 3.8; SD, 1.4 attempts per patient). There was no difference between duration of PIV and IO attempts (0.63; IQR, 0.35-0.96 vs. 0.39 IQR, 0.13-0.65 minutes, adjusted p = 0.03), but both PIV and IO were faster than CVC attempts (3.2; IQR, 1.72-5.23 minutes; adjusted p < 0.001 for both comparisons). Intraosseous lines had higher success rates than PIVs or CVCs (95% vs. 42% vs. 46%, p < 0.001). CONCLUSION Access attempts using IO are as fast as PIV attempts but are more than twice as likely to be successful. Attempts at CVC access in patients in extremis have high rates of failure and take a median of over 3 minutes. While IO access may not completely supplant PIVs and CVCs, IO access should be considered as a first-line therapy for trauma patients in extremis. LEVEL OF EVIDENCE Therapeutic, level III.
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9
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Intraosseous access in children. New applications of an ancient technique. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Use of theory to plan or evaluate guideline implementation among physicians: a scoping review. Implement Sci 2017; 12:26. [PMID: 28241771 PMCID: PMC5327520 DOI: 10.1186/s13012-017-0557-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/14/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This study aimed to describe if and how theory is now used to plan or evaluate guideline implementation among physicians. METHODS A scoping review was conducted. MEDLINE, EMBASE, and The Cochrane Library were searched from 2006 to April 2016. English language studies that planned or evaluated guideline implementation targeted to physicians based on explicitly named theory were eligible. Screening and data extraction were done in duplicate. Study characteristics and details about theory use were analyzed. RESULTS A total of 1244 published reports were identified, 891 were unique, and 716 were excluded based on title and abstract. Among 175 full-text articles, 89 planned or evaluated guideline implementation targeted to physicians; 42 (47.2%) were based on theory and included. The number of studies using theory increased yearly and represented a wide array of countries, guideline topics and types of physicians. The Theory of Planned Behavior (38.1%) and the Theoretical Domains Framework (23.8%) were used most frequently. Many studies rationalized choice of theory (83.3%), most often by stating that the theory described implementation or its determinants, but most failed to explicitly link barriers with theoretical constructs. The majority of studies used theory to inform surveys or interviews that identified barriers of guideline use as a preliminary step in implementation planning (76.2%). All studies that evaluated interventions reported positive impact on reported physician or patient outcomes. CONCLUSIONS While the use of theory to design or evaluate interventions appears to be increasing over time, this review found that one half of guideline implementation studies were based on theory and many of those provided scant details about how theory was used. This limits interpretation and replication of those interventions, and seems to result in multifaceted interventions, which may not be feasible outside of scientific investigation. Further research is needed to better understand how to employ theory in guideline implementation planning or evaluation.
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Blueprint for Implementing New Processes in Acute Care: Rescuing Adult Patients With Intraosseous Access. J Trauma Nurs 2017; 22:266-73. [PMID: 26352658 DOI: 10.1097/jtn.0000000000000152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The intraosseous (IO) access initiative at an urban university adult level 1 trauma center began from the need for a more expeditious vascular access route to rescue patients in extremis. The goal of this project was a multidisciplinary approach to problem solving to increase access of IO catheters to rescue patients in all care areas. The initiative became a collaborative effort between nursing, physicians, and pharmacy to embark on an acute care endeavor to standardize IO access. This is a descriptive analysis of processes to effectively develop collaborative strategies to navigate hospital systems and successfully implement multilayered initiatives. Administration should empower nurse to advance their practice to include IO for patient rescue. Intraosseous access may expedite resuscitative efforts in patients in extremis who lack venous access or where additional venous access is required for life-saving therapies. Limiting IO dwell time may facilitate timely definitive venous access. Continued education and training by offering IO skill laboratory refreshers and annual e-learning didactic is optimal for maintaining proficiency and knowledge. More research opportunities exist to determine medication safety and efficacy in adult patients in the acute care setting.
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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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Krishnan M, Lester K, Johnson A, Bardeloza K, Edemekong P, Berim I. Bent Metal in a Bone: A Rare Complication of an Emergent Procedure or a Deficiency in Skill Set? Case Rep Crit Care 2016; 2016:4382481. [PMID: 28018682 PMCID: PMC5149611 DOI: 10.1155/2016/4382481] [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] [Received: 10/16/2016] [Revised: 10/27/2016] [Accepted: 10/30/2016] [Indexed: 12/04/2022] Open
Abstract
Intraosseous (IO) access is an important consideration in patients with difficult intravenous (IV) access in emergent situations. IO access in adults has become more popular due to the ease of placement and high success rates. The most common sites of access include the proximal tibia and the humeral head. The complications associated are rare but can be catastrophic: subsequent amputation of a limb has been described in the literature. We report a 25-year-old female presenting with diabetic ketoacidosis (DKA) in whom emergent IO access was complicated by needle bending inside the humerus. Conventional bedside removal was impossible and required surgical intervention in operating room.
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Affiliation(s)
- Mridula Krishnan
- Department of Internal Medicine, CHI Creighton University Medical Center, Omaha, NE, USA
| | | | - Amber Johnson
- Creighton University School of Medicine, Omaha, NE, USA
| | - Kaye Bardeloza
- Department of Internal Medicine, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Peter Edemekong
- Department of Family Medicine, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Ilya Berim
- Department of Pulmonary and Critical Care, CHI Creighton University Medical Center, Omaha, NE, USA
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Smereka A, Stawicka I, Czyzewski L. Nurses' knowledge and attitudes toward intraosseous access: preliminary data. Am J Emerg Med 2016; 34:1724. [PMID: 27318743 DOI: 10.1016/j.ajem.2016.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Adam Smereka
- Department and Clinic of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Lukasz Czyzewski
- Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland.
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Wong MR, Reggio MJ, Morocho FR, Holloway MM, Garcia-Blanco JC, Jenkins C, Johnson AD. Effects of intraosseous epinephrine in a cardiac arrest swine model. J Surg Res 2015; 201:327-33. [PMID: 27020815 DOI: 10.1016/j.jss.2015.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/22/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Interruptions in cardiopulmonary resuscitation (CPR) to obtain vascular access reduces blood flow to vital organs. Tibial intraosseous (TIO) access may be a faster alternative to intravenous (IV) access for delivery of vasoactive medications. The purpose of this study was to examine the differences in pharmacokinetics and pharmacodynamics of TIO- and IV-delivered epinephrine. MATERIALS AND METHODS A prospective, between subjects, experimental design comparing Cmax, Tmax, return of spontaneous circulation (ROSC), and time to ROSC. Adult male swine were divided into three equal groups (n = 7) all received CPR and defibrillation: the second group received IV epinephrine and the third group received tibial intraosseous epinephrine. Swine were placed in cardiac arrest for 2 min before CPR was initiated. After 2 min of CPR, epinephrine was delivered by IV or TIO, and serial blood samples were collected over 4 min. RESULTS There were no significant differences between IV versus TIO epinephrine in achieving ROSC, time to ROSC, and Cmax. A one-way analysis of variance demonstrated a significant difference between the IV and TIO groups in Tmax (P = 0.025). A Fisher exact test demonstrated a significant difference between IV epinephrine versus CPR/Defib only (P = 0.035) and TIO epinephrine versus CPR/Defib only (P = 0.010) in achieving ROSC. A multivariate analysis of variance showed significant differences in IV versus intraosseous epinephrine concentration at specific time intervals: 60 (P = 0.023), 90 (P = 0.001), and 120 (P < 0.000) sec. CONCLUSIONS In the context of ROSC, epinephrine delivered via TIO route is a clinically relevant alternative to IV administration. When IV access cannot be immediately obtained in cardiac arrest patients, TIO access should be considered.
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Affiliation(s)
- Marc R Wong
- US Army Medical Department Center and School, Health Readiness Center of Excellence, Graduate school-US Army Graduate Program in Nursing Anesthesia, JBSA-FSH, San Antonio, Texas
| | - Matt J Reggio
- US Army Medical Department Center and School, Health Readiness Center of Excellence, Graduate school-US Army Graduate Program in Nursing Anesthesia, JBSA-FSH, San Antonio, Texas
| | - Freddy R Morocho
- US Army Medical Department Center and School, Health Readiness Center of Excellence, Graduate school-US Army Graduate Program in Nursing Anesthesia, JBSA-FSH, San Antonio, Texas
| | - Monica M Holloway
- US Army Medical Department Center and School, Health Readiness Center of Excellence, Graduate school-US Army Graduate Program in Nursing Anesthesia, JBSA-FSH, San Antonio, Texas
| | - Jose C Garcia-Blanco
- Department of Internal Medicine, Texas Tech University Health Science Center at El Paso, El Paso, Texas
| | - Constance Jenkins
- US Army Medical Department Center and School, Health Readiness Center of Excellence, Graduate school-US Army Graduate Program in Nursing Anesthesia, JBSA-FSH, San Antonio, Texas
| | - Arthur D Johnson
- US Army Medical Department Center and School, Health Readiness Center of Excellence, Graduate school-US Army Graduate Program in Nursing Anesthesia, JBSA-FSH, San Antonio, Texas.
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