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

Abstract

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.

Finding alternative sites for intraosseous infusions in newborns

“…Weiss et al demonstrated age-related variability of the pretibial tissue layer, cortical bone thickness and the diameter of the medullary cavity. 11 Moreover, in a questionnaire, all respondents cited lack of experience as the main reason for insecurity in choosing an IO access 12 in newborn resuscitation, demonstrating that inexperience is a clear disadvantage in performing this procedure. As there are also well known interspecies differences in bone composition and density, 13 creating suitable newborn osseous dummies remains a challenge in order to provide adequate simulation scenario devices.…”

Intraosseous access in neonates is feasible and safe – An analysis of a prospective nationwide surveillance study in Germany

“…Our current study underlines that IO placement during neonatal resuscitation is a widespread practice and demonstrates the feasibility of IO access in the population of neonates. This alternative is supported by a recent online questionnaire study, including 502 health care professionals, which revealed that UVC implementation during an emergency event was rated as very difficult to impossible in 60% by neonatologists and in 90% by non-neonatologists (21). Hence, taking our study results into account, we propose that in certain settings (beyond high-level neonatal units, prehospital or other difficult conditions, inexperienced teams, infant age above 24 h), IO access should be considered the first-choice access in the case of neonatal resuscitation.…”