Blueprint for Implementing New Processes in Acute Care

Chreiman, Kristen; Kim, Patrick K.; Garbovsky, Lyudmila A.; Schweickert, William D.

doi:10.1097/jtn.0000000000000152

Cited by 4 publications

(1 citation statement)

References 39 publications

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“…An injection as such not only provides access to medication but provides access to fluid intake in order to expand the vascular bed and increase blood pressure [1,2]. In emergency medicine, many cases occur requiring intravascular access that should be obtained as soon as possible [3][4][5][6]. Such emergency cases may include the onset of anaphylactic and hypovolemic shock and the necessity to initiate CPR.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two Intraosseous Access Devices Employed During Simulated Cardiopulmonary Resuscitation. A Prospective, Randomized, Crossover, Manikin Study

Ramirez¹,

Truszewski²,

Drozd³

2016

Disaster Emerg Med J

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BACKGROUND: Intraosseous injection is an alternative method used regarding unsuccessful intravenous access during many emergency situations. The aim of the present study was to compare injections made by the Bone Injection Gun (BIG) with NIO Adult intraosseous access devices during simulated CPR performed by paramedics. METHODS: 40 paramedics took part in this prospective, randomized, crossover, manikin study. The participants were chosen at random, while each paramedic performed an intraosseous injection with the Bone Injection Gun (BIG) or with the NIO Adult Intraosseous access device. The effectiveness of the intraosseous injection was analyzed as times T1, T2, and T3. Time T1 is defined as the time-lapse from placing the intraosseous device into one's hand to performing the intraosseous injection; Time T2 is the time-lapse from placing the intraosseous device into one's hand to the moment of stabilizing it at the injection site; while Time T3 is defined as the time-lapse from putting the intraosseous device into one's hand, attaching the syringe with a test aspiration, to connecting the infusion line. Attitudes toward the use of intraosseous access during resuscitation were also analyzed in the present study. RESULTS: The efficacy of intraosseous access obtained with the use of NIO was at 100% where the efficacy of the use of BIG was at 95%. The average time of T1 was similar in the groups randomized to use BIG and NIO, represented as 5.4 ± 3.5 vs. 3.5 ± 2.5 s, respectively (p = 0.014); the average time of T2 was 17.5 ± 4.5 vs. 3.5 ± 2.5 s, respectively (p < 0.001); while the average time of T3 was 25 ± 5.5 vs. 11.5 ± 2.5 s, respectively (p < 0.001). Notably, 90% of the study's participating paramedics preferred to use the NIO during cardiopulmonary resuscitation (p < 0.001). CONCLUSIONS: The present study shows that after a short period of training paramedics can perform an intraosseous injection with a high degree of efficiency. Thus, the authors stress the need for training medical personnel to have the skill to perform intraosseous injections along with knowledge and understanding of the indications and contraindication for IO access.

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Section: Introductionmentioning

confidence: 99%

Comparison of Two Intraosseous Access Devices Employed During Simulated Cardiopulmonary Resuscitation. A Prospective, Randomized, Crossover, Manikin Study

Ramirez¹,

Truszewski²,

Drozd³

2016

Disaster Emerg Med J

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Applied anatomy for tibial intraosseous access in adults

et al. 2017

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Intraosseous access is a method for providing vascular access in resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. There is a lack of detailed description for the landmark for the insertion point in the literature. The aim of this study was to determine the exact location for intraosseous access. Radiographic computed tomography (CT) images of a total of 50 dry tibia bones were obtained. With 5-mm intervals, for all transverse images and by selecting transverse section, measurements were taken from the thickness of the cortex at anterior margin and mid-line medial surface, distance from anterior margin, and mid-line medial surface of the tibia to the posterior wall of medullar cavity, distance from anterior margin and mid-line medial surface of the tibia to the posterior surface of the tibia. The thinner part of the cortex of the tibia and the larger width of the medullar cavity is at 0.5 cm below the tibial tuberosity in the midline of the medial surface. The application region for proximal tibia access and landmark and most suitable insertion point for intraosseous infusion should be at level 0.5 cm below the tibial tuberosity in the midline of the medial surface. It was recommended that standard length for intraosseous canule should be 17 mm except for the thickness of skin. In conclusion, presented study provides certain localization for intraosseous access and standard length for intraosseous canule and this will be more effective in using this technique. Clin. Anat. 31:593-597, 2018. © 2017 Wiley Periodicals, Inc.

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Comparison of the NIO and EZIO for Resuscitative Vascular Access in the Emergency Department: A Quasi-Experimental, Before-and-After Study

et al. 2022

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Introduction Intraosseous (IO) needle insertion is a key adjunctive procedure in the care of critically ill and injured patients in a variety of settings, including the battlefield. The NIO is a new, fully disposable, single-piece, IO device with potential practical advantages under austere conditions. We sought to compare the efficacy and safety of the NIO to an established, well-studied device, the EZIO, when used for resuscitative vascular access in the emergency department (ED). Methods Retrospective, single-center, quasi-experimental, before-and-after, observational cohort study performed at an urban, tertiary-care hospital ED among adult patients receiving IO access during resuscitation. The before/NIO period lasted from July 1, 2019, to May 31, 2020, and the EZIO/after period from June 1, 2020, to April 30, 2021. Patient demographics, prehospital treatment, ED presentation, characteristics and results of IO insertion(s), potential procedure-associated adverse events, and ED and hospital outcomes were abstracted from the medical record. The primary outcome, rate of first-pass success (FPS), was compared between the NIO and EZIO periods using multivariable regression after adjustment for potential confounding factors. Results We enrolled 63 total patients/66 limbs (mean age 61 ± 18, 51% female), 34 patients/35 limbs during the NIO period and 29 patients/31 limbs during the EZIO period. The most common reason for IO insertion was cardiac arrest (40/63, 63%), followed by respiratory failure, trauma, and sepsis. The majority of IO insertions were performed at the proximal tibia (58/66, 88%) by senior emergency medicine residents or faculty. The overall rate of FPS was 53/66 (80%), 24/35 (69%) with the NIO compared to 29/31 (94%) with the EZIO. After multivariable modeling, the odds of FPS with the NIO vs. the EZIO was 0.19 (95% CI, 0.01–1.5, P = .16). Procedure-related adverse events were infrequent in both groups. In-hospital mortality was 45/63 (71%). Conclusions We found that the NIO device was associated with a lower-than-expected rate of FPS compared to the EZIO device, although not significantly different after adjusting for between-group imbalances and considering limitations in the study design. Further, prospective research into the efficacy and safety of the NIO is needed before clinical use can be encouraged.

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Blueprint for Implementing New Processes in Acute Care

Cited by 4 publications

References 39 publications

Comparison of Two Intraosseous Access Devices Employed During Simulated Cardiopulmonary Resuscitation. A Prospective, Randomized, Crossover, Manikin Study

Comparison of Two Intraosseous Access Devices Employed During Simulated Cardiopulmonary Resuscitation. A Prospective, Randomized, Crossover, Manikin Study

Applied anatomy for tibial intraosseous access in adults

Comparison of the NIO and EZIO for Resuscitative Vascular Access in the Emergency Department: A Quasi-Experimental, Before-and-After Study

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