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Ott T, Demare T, Möhrke J, Silber S, Schwab J, Reuter L, Westhphal R, Schmidtmann I, Dietz SO, Pirlich N, Ziebart A, Engelhard K. Does an instructional video as a stand-alone tool promote the acquisition of practical clinical skills? A randomised simulation research trial of skills acquisition and short-term retention. BMC MEDICAL EDUCATION 2024; 24:714. [PMID: 38956562 PMCID: PMC11221112 DOI: 10.1186/s12909-024-05714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The effectiveness of instructional videos as a stand-alone tool for the acquisition of practical skills is yet unknown because instructional videos are usually didactically embedded. Therefore, we evaluated the acquisition of the skill of a humeral intraosseous access via video in comparison to that of a self-study with an additional retention test. METHODS After ethical approval, we conducted two consecutive studies. Both were designed as randomised controlled two-armed trials with last-year medical students as independent samples at our institutional simulation centre of a tertiary university hospital centre. In Study 1, we randomly assigned 78 participants to two groups: Vid-Self participants watched an instructional video as an intervention, followed by a test, and after seven days did a self-study as a control, followed by a test. Self-Vid ran through the trial in reverse order. In Study 2, we investigated the influence of the sequence of the two teaching methods on learning success in a new sample of 60 participants: Vid-Self watched an instructional video and directly afterward did the self-study followed by a test, whereas Self-Vid ran through that trial in reverse order. In Studies 1 and 2, the primary outcome was the score (worst score = 0, best score = 20) of the test after intervention and control. The secondary outcome in Study 1 was the change in score after seven days. RESULTS Study 1: The Vid-Self (Participants n = 42) was superior to the Self-Vid (n = 36) (mean score 14.8 vs. 7.7, p < 0.001). After seven days, Self-vid outperformed Vid-Self (mean score 15.9 vs. 12.5, p < 0.001). Study 2: The Vid-Self (n = 30) and Self-Vid (n = 30) scores did not significantly differ (mean 16.5 vs. mean 16.5, p = 0.97). CONCLUSION An instructional video as a stand-alone tool effectively promotes the acquisition of practical skills. The best results are yielded by a combination of an instructional video and self-study right after each other, irrespective of sequence. TRIAL REGISTRATIONS ClinicalTrials.gov: NCT05066204 (13/04/2021) (Study 1) and NCT04842357 (04/10/2021) (Study 2).
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Affiliation(s)
- Thomas Ott
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany.
| | - Tim Demare
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Julia Möhrke
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Saskia Silber
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Johannes Schwab
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Lukas Reuter
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Ruben Westhphal
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centerof the, Johannes Gutenberg-University Mainz, Obere Zahlbacher Str. 69, Mainz, 55131, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centerof the, Johannes Gutenberg-University Mainz, Obere Zahlbacher Str. 69, Mainz, 55131, Germany
| | - Sven-Oliver Dietz
- Department of Orthopaedics and Traumatology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Nina Pirlich
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Alexander Ziebart
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Kristin Engelhard
- Department of Anaesthesiology, University Medical Centerof the, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
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Chiang T, Teichman AL. Resuscitation and Evaluation With Intraosseous Access: A Review of the Literature in Trauma and Non-Trauma Patients. Am Surg 2024; 90:1608-1617. [PMID: 38197763 DOI: 10.1177/00031348241227169] [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] [Indexed: 01/11/2024]
Abstract
According to trauma resuscitation guidelines, intraosseous (IO) access is appropriate when failure to gain intravenous (IV) access is present in trauma, burn, shock, or resuscitation settings for adults or when two failed attempts have been made in the resuscitation of a pediatric patient. However, their effectiveness and use have been debated due to concerns on flow rates, extravasation, compartment syndrome, and osteomyelitis. The objective of this review is to examine the current literature regarding intraosseous access in trauma resuscitation, focusing on interventions and complication rates.
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Affiliation(s)
- Taylor Chiang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amanda L Teichman
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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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.
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Affiliation(s)
| | | | - Alba García-Viola
- Servicio de Urgencias de Atención Primaria de Distrito Sanitario Almería
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Uzan OC, Guieu LS, Hall KE, Tucker CD, Webb TL, Dunn J, Guillaumin J. Comparison of placement characteristics using two intraosseous devices in canine and feline cadavers by novice users. Front Vet Sci 2023; 10:1196284. [PMID: 37546338 PMCID: PMC10397382 DOI: 10.3389/fvets.2023.1196284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Intraosseous (IO) catheterization enables rapid access to systemic circulation in critical patients. A battery-powered IO device (BPIO) utilized in veterinary practice is reliable in facilitating IO catheter placement. A new spring-powered IO device (SPIO) has been developed for people but has not been tested in veterinary patients. The goal of our study was to compare placement characteristics and flow rates achieved with the BPIO compared to the SPIO in animals when operated by novice users. Methods Six veterinary students performed 72 catheterizations in the humeri and tibias of 12 dog and 6 cat cadavers. The user, cadaver, device, and site of placement were randomized. Flow rates were determined by three-minute infusions. Results In dogs, overall success rates (50% BPIO, 46% SPIO; p = 0.775) and flow rates based on location were similar between devices. Successful placement was faster on average with the BPIO (34.4 s for BPIO and 55.0 s for SPIO, p = 0.0392). However, time to successful placement between devices was not statistically significant based on location (humerus: 34.7 s for BPIO and 43.1 s for SPIO, p = 0.3329; tibia: 33.3 s for BPIO and 132.6 s for SPIO, p = 0.1153). In cats, success rates were similar between devices (16.7% for BPIO and 16.7% for SPIO, p = 1.000), but limited successful placements prevented further analysis. Discussion This is the first study to examine the use of the SPIO in animals, providing preliminary data for future IO studies and potential applications for training in the clinical setting.
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Affiliation(s)
- Olivia C. Uzan
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Liz S. Guieu
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Kelly E. Hall
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Claire D. Tucker
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Tracy L. Webb
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Julie Dunn
- Medical Center of the Rockies, University of Colorado Health, Loveland, CO, United States
| | - Julien Guillaumin
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
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Sunde GA, Bjerkvig C, Bekkevold M, Kristoffersen EK, Strandenes G, Bruserud Ø, Apelseth TO, Heltne JK. Implementation of a low-titre whole blood transfusion program in a civilian helicopter emergency medical service. Scand J Trauma Resusc Emerg Med 2022; 30:65. [PMID: 36494743 PMCID: PMC9733220 DOI: 10.1186/s13049-022-01051-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early balanced transfusion is associated with improved outcome in haemorrhagic shock patients. This study describes the implementation and evaluates the safety of a whole blood transfusion program in a civilian helicopter emergency medical service (HEMS). METHODS This prospective observational study was performed over a 5-year period at HEMS-Bergen, Norway. Patients in haemorrhagic shock receiving out of hospital transfusion of low-titre Group O whole blood (LTOWB) or other blood components were included. Two LTOWB units were produced weekly and rotated to the HEMS for forward storage. The primary endpoints were the number of patients transfused, mechanisms of injury/illness, adverse events and survival rates. Informed consent covered patient pathway from time of emergency interventions to last endpoint and subsequent data handling/storage. RESULTS The HEMS responded to 5124 patients. Seventy-two (1.4%) patients received transfusions. Twenty patients (28%) were excluded due to lack of consent (16) or not meeting the inclusion criteria (4). Of the 52 (100%) patients, 48 (92%) received LTOWB, nine (17%) received packed red blood cells (PRBC), and nine (17%) received freeze-dried plasma. Of the forty-six (88%) patients admitted alive to hospital, 35 (76%) received additional blood transfusions during the first 24 h. Categories were blunt trauma 30 (58%), penetrating trauma 7 (13%), and nontrauma 15 (29%). The majority (79%) were male, with a median age of 49 (IQR 27-70) years. No transfusion reactions, serious complications or logistical challenges were reported. Overall, 36 (69%) patients survived 24 h, and 28 (54%) survived 30 days. CONCLUSIONS Implementing a whole blood transfusion program in civilian HEMS is feasible and safe and the logistics around out of hospital whole blood transfusions are manageable. Trial registration The study is registered in the ClinicalTrials.gov registry (NCT02784951).
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Affiliation(s)
- Geir Arne Sunde
- grid.412008.f0000 0000 9753 1393Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,Helicopter Emergency Medical Services, Bergen, Norway
| | - Christopher Bjerkvig
- grid.412008.f0000 0000 9753 1393Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,Helicopter Emergency Medical Services, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Marit Bekkevold
- grid.420120.50000 0004 0481 3017Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Einar K. Kristoffersen
- grid.7914.b0000 0004 1936 7443Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Geir Strandenes
- grid.412008.f0000 0000 9753 1393Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Bruserud
- grid.412008.f0000 0000 9753 1393Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Torunn Oveland Apelseth
- grid.7914.b0000 0004 1936 7443Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway ,grid.457897.00000 0004 0512 8409Norwegian Armed Forces Joint Medical Service, Sessvollmoen, Norway
| | - Jon-Kenneth Heltne
- grid.412008.f0000 0000 9753 1393Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,Helicopter Emergency Medical Services, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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Flow Rate Considerations for Intraosseous Catheter Use. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clinical Management of Intraosseous Access in Adults in Critical Situations for Health Professionals. Healthcare (Basel) 2022; 10:healthcare10020367. [PMID: 35206981 PMCID: PMC8871650 DOI: 10.3390/healthcare10020367] [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: 12/14/2021] [Revised: 01/30/2022] [Accepted: 02/11/2022] [Indexed: 12/10/2022] Open
Abstract
There are health professionals who are unaware of the ideal management of the intraosseous route, despite the fact that it has been scientifically considered an alternative to the peripheral venous route when the patient is in critical condition. Thanks to continuous development, there has been a need to provide emergency services with materials that manage to provide satisfactory care, despite the difficulties faced by health personnel. Objectives: The objective of this systematic bibliographic review is to update the theoretical and practical knowledge and strategies for the insertion and proper management of the intraosseous route as an emergency vascular access for nursing professionals. Data sources, study eligibility criteria: The search for the articles was carried out in various scientific databases with the help of a search string (January 2015 and May 2021), which combined the keywords and Boolean operators. Study appraisal and synthesis methods: Eighteen articles were chosen after a review of 1920 database articles, following the application of the inclusion and exclusion criteria. Results: Intraosseous infusion is an effective and safe technique, which increases patient survival. Therefore, it is of crucial importance that all nursing professionals know how to handle the different intraosseous devices in situations in which it is not possible to achieve immediate peripheral venous access. Conclusions and implications of key findings: It is of great need to have devices or fast and effective alternatives that allow us to develop safe interventions by health professionals.
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Drozd A, Wolska M, Szarpak L. Intraosseous vascular access in emergency and trauma settings: a comparison of the most universally used intraosseous devices. Expert Rev Med Devices 2021; 18:855-864. [PMID: 34325586 DOI: 10.1080/17434440.2021.1962287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Obtaining successful vascular access is an essential component of the emergency and trauma setting. The modern practice of medicine advocates IO access for patients in a critical condition, especially when IV access is problematic or unobtainable. Various medical devices allowing for IO access have been coined and used in the management of critical patients.Areas covered: This study aims to review the literature regarding different intraosseous devices used to obtain vascular access (Bone Injection Gun (BIG), EZ-IO, NIO, Jamshidi, and First Access for Shock and Trauma (FAST-1) and discuss their clinical and experimental role in the emergency and trauma settings.Expert opinion: The development of medical technology contributes to an increasing number of intraosseous devices facilitating vascular access in challenging scenarios, including cardiopulmonary resuscitation, anaphylactic, or hypovolemic shock. Each of these devices provides an effective route for fluid resuscitation, drug delivery, laboratory evaluation, and shortening the timeframe for established vascular access, provided that the person obtaining the access is acquainted with the use of the device.
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Affiliation(s)
- Anna Drozd
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marta Wolska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
| | - Lukasz Szarpak
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.,Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland.,Outcomes Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
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Hamam MS, Klausner HA, France J, Tang A, Swor RA, Paxton JH, O'Neil BJ, Brent C, Neumar RW, Dunne RB, Reddi S, Miller JB. Prehospital Tibial Intraosseous Drug Administration is Associated with Reduced Survival Following Out of Hospital Cardiac Arrest: A study for the CARES Surveillance Group. Resuscitation 2021; 167:261-266. [PMID: 34237357 DOI: 10.1016/j.resuscitation.2021.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/09/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent reports have questioned the efficacy of intraosseous (IO) drug administration for out-of-hospital cardiac arrest (OHCA) resuscitation. Our aim was to determine whether prehospital administration of resuscitative medications via the IO route was associated with lower rates of return of spontaneous circulation (ROSC) and survival to hospital discharge than peripheral intravenous (IV) infusion in the setting of OHCA. METHODS We obtained data on all OHCA patients receiving prehospital IV or IO drug administration from the three most populous counties in Michigan over three years. Data was from the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) database. The association between route of drug administration and outcomes was tested using a matched propensity score analysis. RESULTS From a total of 10,626 OHCA patients, 6869 received parenteral drugs during their prehospital resuscitation (37.8% by IO) and were included in analysis. Unadjusted outcomes were lower in patients with IO vs. IV access: 18.3% vs. 23.8% for ROSC (p < 0.001), 3.2% vs. 7.6% for survival to hospital discharge (p < 0.001), and 2.0% vs. 5.8% for favorable neurological function (p < 0.001). After adjustment, IO route remained associated with lower odds of sustained ROSC (OR 0.72, 95% CI 0.63-0.81, p < 0.001), hospital survival (OR 0.48, 95% CI 0.37-0.62, p < 0.001), and favorable neurological outcomes (OR 0.42, 95% CI 0.30-0.57, p < 0.001). CONCLUSION In this cohort of OHCA patients, the use of prehospital IO drug administration was associated with unfavorable clinical outcomes.
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Affiliation(s)
- Mohamed Serhan Hamam
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA; Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA.
| | - Howard A Klausner
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - John France
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Amy Tang
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Robert A Swor
- Department of Emergency Medicine, Beaumont Health, Royal Oak, MI, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Christine Brent
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Robert B Dunne
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Swetha Reddi
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Joseph B Miller
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
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Laney JA, Friedman J, Fisher AD. Sternal Intraosseous Devices: Review of the Literature. West J Emerg Med 2021; 22:690-695. [PMID: 34125048 PMCID: PMC8202990 DOI: 10.5811/westjem.2020.12.48939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction The intraosseous (IO) route is one of the primary means of vascular access in critically ill and injured patients. The most common sites used are the proximal humerus, proximal tibia, and sternum. Sternal IO placement remains an often-overlooked option in emergency and prehospital medicine. Due to the conflicts in Afghanistan and Iraq the use of sternal IOs have increased. Methods The authors conducted a limited review, searching PubMed and Google Scholar databases for “sternal IO,” “sternal intraosseous,” and “intraosseous” without specific date limitations. A total of 47 articles were included in this review. Results Sternal IOs are currently FDA approved for ages 12 and older. Sternal IO access offers several anatomical, pharmacokinetic, hemodynamic, and logistical advantages over peripheral intravenous and other IO points of access. Sternal IO use carries many of the same risks and limitations as the humeral and tibial sites. Sternal IO gravity flow rates are sufficient for transfusing blood and resuscitation. In addition, studies demonstrated they are safe during active CPR. Conclusion The sternal IO route remains underutilized in civilian settings. When considering IO vascular access in adults or older children, medical providers should consider the sternum as the recommended IO access, particularly if the user is a novice with IO devices, increased flow rates are required, the patient has extremity trauma, or administration of a lipid soluble drug is anticipated.
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Affiliation(s)
- Jared A Laney
- Texas A&M University College of Medicine, Bryan, Texas
| | | | - Andrew D Fisher
- Medical Command, Texas Army National Guard, Austin, Texas.,University of New Mexico School of Medicine, Department of Surgery, Albuquerque, New Mexico
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The Role of the Registered Nurse in the Use of Intraosseous Vascular Access Devices. JOURNAL OF INFUSION NURSING 2020; 43:117-120. [DOI: 10.1097/nan.0000000000000369] [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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