Efficiency, efficacy and confidence with drill-assisted as compared to manual intraosseous needle placement in a newborn model.

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Submission ID :
ESPR482
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Abstract: :

Title:

Efficiency, efficacy and confidence with drill-assisted as compared to manual intraosseous needle placement in a newborn model.


Background:

The Neonatal Resuscitation Program recommends intraosseous (IO) access as an alternative route for medications during resuscitation when vascular access cannot be obtained. However, most trained providers have limited or no experience with the use of an IO device and data regarding provider's experience with this skill in a newborn are scarce. Furthermore, there are currently no studies which have compared provider efficiency, efficacy and confidence with drill-assisted as compared to manual IO needle placement in a size-appropriate simulated newborn model.


Objective:

To determine whether there is a difference in efficiency, efficacy and confidence in neonatal IO placement with drill-assisted device as compared to manual insertion.


Design/Methods:

This IO placement study was embedded in a prospective, randomized trial to evaluate pharmacokinetics and efficacy of IO epinephrine. The newborn ovine asphyxia model affords optimal procedural simulation as term lambs are comparable in size to a newborn. IO access was placed in asphyxiated study animals prior to resuscitation. The method of IO access placement was designated by a randomly selected treatment card. IO needles were inserted on the flat surface of the tibia, medial to the tibial tuberosity. Time to placement and success rates (defined as presence of blood aspirate) was recorded. A post intervention survey was completed by providers. The survey assessed confidence with insertion and placement as well as ease of aspiration and securement using a 5-point Likert scale. Outcomes and responses were compared by Student's t-test with significance defined as p < 0.05.


Results:

A total of 38 procedures were performed by 12 providers during the study period. The average time to obtain IO access was 9.6 seconds faster with the drill-assisted device (Figure 1). Success rates were 68% with a manual IO as compared to 95% with a drill assisted device, but this difference was not significant. Drill-assisted placement also resulted in higher scores for confidence with insertion and placement as well as ease of aspiration and securement (Figure 2).


Conclusion:

IO needle placement was found to be faster with the drill-assisted device, however this difference may be of limited clinical relevance. Importantly, there were significant differences in the perceived confidence and procedural ease with drill-assistance. As healthcare professionals commonly lack experience with this procedure, access to appropriate simulation models, education and equipment for clinical use with newborn care is warranted.

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University at Buffalo
University of Washington

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