Intraosseous access: a simulation analysis
- IO Access,
- Nursing Student
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.
- 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),
- 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.