Keywords
Simulation
Teaching
Nursing Student
How to Cite
Abstract
Introduction: The priority in critical patients is to find a vascular access. The most used access is the peripheral venous access, but when its placement goes wrong or is difficult, the literature recommends implementing intraosseous (IO) access as a valid alternative. The IO access is a rapid, reliable and a relatively safe method. Despite the recommendations, IO access is rarely used when indicated. The objective of this study was to evaluate the critical points of the IO procedure, positioning time, percentage of success at first attempt in simulation and, in according to obtained outcomes, checking of the procedure inclusion within university programs.
Material and methods: A sample of 84 people was recruited; among them 44 were students attending the third year of the Degree Course in Nursing of the University of Turin (site of Asti) and 40 nurses from intensive care unit and emergency ward of Cardinal Massaia Hospital of Asti. A short lesson about IO access took place, followed by a practical demonstration. Subsequently, the IO access insertion performance and difficulty perceived were evaluated. Statistical analysis was performed by means of inferential and descriptive bivariate analysis.
Results: The average value of the performance “IO access insertion” was 12.2±1.22 (average of the assigned points by the sample). The average difficulty perceived was 1.65±0.42, and mainly found in “selection of the correct point of insertion” with a value of 2.64±0.87, “needle placement” with a medium value of 2.35±1.02 and “medication” with a value of 2.0±0.94. Average execution time of IO access and needle placement were 73.3 and 36.1 seconds, respectively. Finally, the success rate at the first attempt was 72.6%.
Discussion: The IO access execution time, for the complete procedure and for the needle placement only, was below the 3 minutes. Among nurses and students, data of the success of the procedure show significant results, but the difference between subgroups is still lower than expected considering
the results of the statistical analysis about procedure success, execution time and error percentage. Most critical issues were found in the retrieval of area of insertion, whereas the most difficulty perceived was on reference point selection, correct needle placement and medication. The procedure may become subject of teaching in the University.
Conclusion: The study evaluates the possibility of the IO access use, by underlining how is necessary a training about it. The principal reason of ‘non-use’ of this device is the disinformation of healthcare professionals. The results seem to underline the importance of a possible integration of IO access technique in the programs of Degree Nursing Course and post-base course. This may improve nursing in emergency situations and therefore, patient outcomes. When healthcare staff training is possible, periodical refresh is particularly recommended in order to maintain the acquired skills.
References
Nurse24.it, Link: https://www.nurse24.it/studenti/procedure/intraossea-una-valida-alternativa-all-accessovenoso.
html (Latest consultation: 02/22. Last edit: 6/18)
Dornhofer P and Kellar J. Z. Intraosseous Vascular Access. In StatPearls. StatPearls Publishing. 2020.
Chreiman K M, Dumas R P, Seamon M J et al. The intraosseous have it: A prospective observational study of
vascular access success rates in patients in extremis using video review. The journal of trauma and acute care
surgery. 2018; 84(4), 558–63.
Feldman O, Nasrallah N, Bitterman Y et al. Pediatric Intraosseous Access Performed by Emergency
Department Nurses Using Semiautomatic Devices: A Randomized Crossover Simulation Study. Pediatric
emergency care. 2021; 37(9), 442–6.
Isayama, K, Nakatani T, Tsuda M et al. Current status of establishing a venous line in CPA patients by
Emergency Life-Saving Technicians in the prehospital setting in Japan and a proposal for intraosseous
infusion. International journal of emergency medicine. 2012; 5(1), 2.
F. Petitpas, J. Guenezan, T. Vendeuvre,M. Scepi, D. Oriot, O. Mimoz. Use of intra-osseous access in adults: a
systematic review. Critical care. 2016
Anson, J. A. Vascular Access in ResuscitationIs There a Role for the Intraosseous Route? Anesthesiology: The
Journal of the American Society of Anesthesiologists, 120(4), 1015–1031. 2014
Clemency, B., Tanaka, K., May, P., Innes, J., Zagroba, S., Blaszak, J., Hostler, D., Cooney, D., McGee, K.,
& Lindstrom, H. Intravenous vs. Intraosseous access and return of spontaneous circulation during out of
hospital cardiac arrest. The American Journal of Emergency Medicine, 35(2), 222–226. 2017
Phillips, L., Brown, L., Campbell, T., Miller, J., Proehl, J., & Youngberg, B. Recommendations for the Use of
Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Health Care Settings: A
Consensus Paper. Critical care nurse, 30, e1-7. 2010
Petitpas F, Guenezan J, Vendeuvre T, et al. Use of intra-osseous access in adults: a systematic review. Critical
care. 2016; 20, 102.
Cotte J, Prunet B, d'Aranda E et al. A compartment syndrome secondary to intraosseous infusion. Annales
francaises d'anesthesie et de reanimation. 2011; 30(1), 90–1.
H. Peyton Young. Strategic Learning and its limitts. Oxford UK: Oxford University Press. 2004
Decreto 22 ottobre 2004, n.° 270. Gazzetta Ufficiale. Roma, 2004
Leidel B, Kirchoff C, Bogner V et al. Comparison of intraosseous versus central venous vascular access in
adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation.
; 83:40-45
Kwon O Y, Park S Y and Yoon T Y. Educational effect of intraosseous access for medical students. Korean
journal of medical education. 2014; 26(2), 117–24.
Brunette D D and Fischer R. Intravascular access in pediatric cardiac arrest. The American journal of
emergency medicine. 1988; 6(6), 577–9.
Brenner T, Bernhard M, Helm M, Doll S, Völkl A, Ganion N, Friedmann C, Sikinger M, Knapp J, Martin E,
Gries A. Comparison of two intraosseous infusion systems for adult emergency medical use. Resuscitation.
Sep;78(3):314-9. doi: 10.1016/j.resuscitation.2008.04.004. Epub 2008 Jun 24. PMID: 18573590.
Orlowski J P. Emergency alternatives to intravenous access. Intraosseous, intratracheal, sublingual, and
other-site drug administration. Pediatric clinics of North America. 1994; 41(6), 1183–99.
Afzali M, Kvisselgaard A D, Lyngeraa T S et al. Intraosseous access can be taught to medical students using
the four-step approach. BMC medical education. 2017; 17(1), 50.
Hallas P. Challenges in the use of intraosseous access. The Indian journal of medical research. 2016; 143(3),
–3.
Schwartz D, Amir L, Dichter R et al. The use of a powered device for intraosseous drug and fluid administration
in a national EMS: a 4-year experience. The Journal of trauma. 2008; 64(3), 650–5.
Gazin N, Auger H, Jabre P et al. Efficacy and safety of the EZ-IO™ intraosseous device: Out-of-hospital
implementation of a management algorithm for difficult vascular access. Resuscitation. 2011; 82(1), 126–9.
Szarpak L, Truszewski Z, Smereka Jet al. A Randomized Cadaver Study Comparing First-Attempt Success
Between Tibial and Humeral Intraosseous Insertions Using NIO Device by Paramedics: A Preliminary
Investigation. Medicine. 2016; 95(20), e3724.
D. Lgs 30 dicembre 1992, n.° 502, integrato dal D. Lgs 229/1999 e implementato a partire dal 2002. Gazzetta
Ufficiale. Roma, 1992.
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