Anatomical investigations on intraosseous access in stillborns – Comparison of different devices and techniques

Fuchs, Zeynep; Scaal, Martin; Haverkamp, Heinz; Koerber, Friederike; Persigehl, Thorsten; Eifinger, Frank

doi:10.1016/j.resuscitation.2018.04.003

Cited by 21 publications

(11 citation statements)

References 19 publications

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“…Besides that, the IO access is a non-natural access route with a complication rate of 13% [9] such as fractures, limb ischaemia and need for amputation [20,21]. The complications are higher in smaller infants due to the small margin of error when inserting an IO device [22].The "risk of a bone injury" and "causing pain" were the main reasons cited in our survey why respondents would not apply an IO access.…”

Section: Discussionmentioning

confidence: 89%

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Evaluating practioners’ preferences regarding vascular emergency access in newborn infants in the delivery room: a national survey

2020

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Background: Venous access during neonatal emergencies in the delivery room (DR) can be accomplished through an umbilical venous catheter (UVC) or an intraosseous (IO) access. Preference of one over the other is unclear. We wanted to evaluate practioners' views. Methods: An anonymous online questionnaire was circulated to healthcare professionals with different background and experience, all working in neonatal intensive care units in Germany. The web-based survey consisted of 13 questions and data collection was performed using an online tool. Results: We received 502 completed questionnaires, 152 (30%) were from neonatologists, the remainder from residents, fellows and neonatal nurses. For resuscitation of term newborns in the DR 61% of neonatologists vs. 53% of non-neonatologists were in favour of UVC instead of an IO as an emergency access. UVC placement was rated (very) difficult to impossible by 60% of neonatologists and 90% of non-neonatologists (p < 0.05). All respondents cited lack of experience as the main reason for feeling reluctant to place an UVC or IO access, the latter only being taken into consideration in term infants. Conclusions: UVC placement in the DR is rated more often difficult to use by non-neonatologists than by neonatologists, apparently related to lack of experience. IO access was only considered for resuscitating term infants due to lacking practice and missing approval for birth weights < 3000 g. Frequent training might improve these clinical skills.

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Section: Discussionmentioning

confidence: 89%

“…A recent trial in 16 stillborns showed success rates in newborns between 40% and 60%, depending on the needle used [22]. However, checking the correct position of an IO access with a CT-scan is difficult to accomplish during neonatal resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Evaluating practioners’ preferences regarding vascular emergency access in newborn infants in the delivery room: a national survey

2020

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“…Another reason for our lower success rate may be the IO access device itself. Fuchs et al (15) reported highest success rates with the manual technique using a Butterfly needle (61.1%), followed by hand-twisted EZ-IO needle insertion (43%) and then the semi-automatic needle insertion using the Arrow EZ-IO system (39.7%). However, it has to be noted that our clinical results using the semi-automatic Arrow EZ-IO system were considerably better than the ones from Fuchs et al (15) in preterm and term stillborns.…”

Section: Discussionmentioning

confidence: 99%

Use of Intraosseous Vascular Access During Neonatal Resuscitation at a Tertiary Center

2020

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Introduction: Emergency vascular access is rarely required during neonatal resuscitation. We aimed to analyze frequency of use, success, and complication rates of intraosseous (IO) vascular access in neonates at a single tertiary neonatal intensive care unit. Method: We performed a questionnaire-based survey among pediatric residents, pediatricians, and neonatologists, asking for the use of IO access in neonates between April 1st, 2015, and April 30th, 2020. We then reviewed electronic patient charts of all identified neonates for demographic data as well as indications and complications of IO puncture. Results: All 41 questionnaires were answered. Nine physicians had attempted IO access 15 times in a total of 12 neonates. Among them were eight term neonates, three preterm neonates, and one former extreme preterm neonate at a post-menstrual age of 42 weeks (m:f = 6:6). The overall success rate was 75%. IO access was attempted primarily during post-natal resuscitation (11/12 neonates, 91.7%) and after unsuccessful peripheral venous puncture (8/12 neonates, 66.7%). It was used to administer adrenaline, fluid and/or blood, and emergency sedation after intubation. Minor short-term complications were reported in three of nine successful IO punctures (33.3%). Discussion: Over the study period of 61 months, IO access was rarely attempted during neonatal resuscitation. Our success rate was lower than reported elsewhere, suggesting that IO puncture may be more challenging in neonates than in older infants and children. No severe short-term complications occurred.

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“…13, Abb. 14) [26]. Die auf dem Markt erhältlichen intraossären Nadeln unterscheiden sich lediglich in ihrer Länge, der Durchmesser ist mit 1,8 mm immer identisch.…”

Section: Take Home Messageunclassified

(Gefäß-)Anatomie im Neugeborenen-, Säuglings- und Kleinkindesalter

Eifinger¹,

Fuchs²

2020

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Anatomical investigations on intraosseous access in stillborns – Comparison of different devices and techniques

Cited by 21 publications

References 19 publications

Evaluating practioners’ preferences regarding vascular emergency access in newborn infants in the delivery room: a national survey

Evaluating practioners’ preferences regarding vascular emergency access in newborn infants in the delivery room: a national survey

Use of Intraosseous Vascular Access During Neonatal Resuscitation at a Tertiary Center

(Gefäß-)Anatomie im Neugeborenen-, Säuglings- und Kleinkindesalter

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