Article, Emergency Medicine

Are junior doctors trained to use to use intraosseous access?

junior doctors trained to use to use”>Correspondence / American Journal of Emergency Medicine 32 (2016) 100112

Lukasz Czyzewski, PhD, RN

107

Lukasz Szarpak, PhD, EMT-P, MPH

Department of Nephrologic Nursing, Medical University of Warsaw

Warsaw, Poland

http://dx.doi.org/10.1016/j.ajem.2015.10.024

Are junior doctors trained to use to use intraosseous access??

To the Editor,

Peripheral Intravenous access is preferred in the treatment of critical patients in prehospital emergency settings. However, IV might be difficult, especially in dehydrated patients, those in shock, following chemotherapy, obese with edema or IV Drug users. Failure rates of IV access in the emergency setting are described around 10-40% and aver- age time needed for peripheral IV catheterization is reported between

2.5 and 16 min in patients with difficult IV access [1]. The use of intraosseous (IO) access in medical or trauma resuscitation is endorsed by the European Resuscitation Council, the American College of Critical Care Medicine, the American Heart Association, the American College of Emergency Physicians or even the US Army Committee on Tactical Combat Casualty Care. These organizations recommend IO access as the immediate alternative route if IV access cannot be rapidly obtained [2,3].

The common site of intraosseous access reported in adults was the humeral head and distal tibia [4]. Correct IO needle placement can be confirmed by observing clinical findings such as the IO needle’s ability to aspirate blood or bone marrow, and the ability to infuse fluid easily without extravasation or swelling [5]. There has been extensive re- search describing the safety and efficacy of IO cannula insertion in emer- gency situations [5]. AS show Levitan et al [6] in their study IO access is characterized by a rapid learning curve and an effectiveness equivalent to peripheral venous cannulation in terms of pharmacokinetic and clin- ical efficacy.

In this study, we evaluated the knowledge of IO access among

junior doctors, participating in emergency medicine training orga- nized by Department of Emergency Medicine, Medical University of Warsaw. The study involved 60 physicians who have completed various medical universities in Poland. The research tool was a ques- tionnaire survey.

Of all respondents, no person previously performed IO access. Among respondents, only 6.7% of people during his medical studies have practical and theoretical IO access training, 21.7% of participants declaring that took theoretical training. Other 71.7% participants during medical studiesdid not have training related to the IO access. All persons on the other hand think that such training should be mandatory for phy- sicians staff. Only one person was unable to indicate the correct location of IO injection, 91.7% chosen tibia as an the injection site, but could not specify the detailed location of IO access, 6.7% of people were unable to identify any potential IO location.

Of participants, 98.3% would use IO access in case when unable to IV access, and 10% during cardiac arrest. As a potential IO complication, participants most often pointed infection (65.0%), bleeding (13.3%), and Bone damage (5.0%).

One hundred percent of respondents believe that the IO access de- vice should be an essential piece of resuscitation kit, while 65.0% of peo- ple think that IO access should be the first way to intravascular access during resuscitation.

In summary, knowledge of junior doctors concerning of IO access is insufficient. During his medical studies it is advisable to introduce train- ings from the IO access, which can be an alternative to difficulty in ve- nous cannulation situations.

Department of Emergency Medicine, Medical University of Warsaw

Warsaw, Poland

Andrzej Kurowski, PhD, MD

Department of Anesthesiology, Cardinal Wyszynski National Institute of

Cardiology, Warsaw, Poland

Piotr Adamczyk, MS

Student Research Circle at the Department of Emergency Medicine Medical

University of Warsaw, Warsaw, Poland

Lukasz Czyzewski, PhD, RN

Department of Nephrologic Nursing, Medical University of Warsaw

Warsaw, Poland

Zenon Truszewski, Ph.D., MD

Department of Emergency Medicine, Medical University of Warsaw

Warsaw, Poland Corresponding author at: Department of Emergency Medicine Medical University of Warsaw, Lindleya Str. 4, 02-005 Warsaw, Poland

Tel.: +48 502258562

Email address: [email protected]

Piotr Zasko, MD

Department of Anesthesiology, Cardinal Wyszynski National Institute of

Cardiology, Warsaw, Poland

http://dx.doi.org/10.1016/j.ajem.2015.10.020

References

  1. Lapostolle F, Catineau J, Garrigue B, Monmarteau V, Houssaye T, Vecci I, et al. Prospec- tive evaluation of Peripheral venous access difficulty in emergency care. Intensive Care Med 2007;33(8):1452-7.
  2. Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, et al. Part 10: Pediatric basic and advanced life support: 2010 International Consensus on Cardio- pulmonary Resuscitation and Emergency Cardiovascular Care Science With Treat- ment Recommendations. Circulation 2010;122(16 Suppl. 2):S466-515. http://dx. doi.org/10.1161/CIRCULATIONAHA.
  3. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. European Resuscita- tion Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010;81(10):1305-52. http://dx.doi.org/10.1016/j.resuscitation.2010.

    08.017.

    Kurowski A, Timler D, Evrin T, Szarpak L. Comparison of 3 different intraosseous ac- cess devices for adult during resuscitation. Randomized crossover manikin study. Am J Emerg Med 2014;32(12):1490-3. http://dx.doi.org/10.1016/j.ajem.2014.09.007.

  4. Tobias JD, Ross AK. Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use. Anesth Analg 2010;110(2):391-401. http://dx.doi.org/10. 1213/ANE.0b013e3181c03c7f.
  5. Levitan RM, Bortle CD, Snyder TA, Nitsch DA, Pisaturo JT, Butler KH. Use of a battery- operated needle driver for intraosseous access by novice users: Skill acquisition with cadavers. Ann Emerg Med 2009;54(5):692-4. http://dx.doi.org/10.1016/j. annemergmed.2009.06.012.

    South African flag sign: a teaching tool for easier ECG recognition of high lateral infarct

    To the Editor,

    We read with great interest the case report by Drs Durant and Singh on the peculiar pattern of ST elevation caused by acute occlusion of the first diagonal branch of the left anterior descending coronary artery (LAD-D) [1]. In our experience too, such high lateral infarcts (STEMIs)

Leave a Reply

Your email address will not be published. Required fields are marked *