Critical Care: Miscellaneous Critical Care |

A Synopsis of Intraosseous Access Workshop in Internal Medicine Residents FREE TO VIEW

Omair Tahir, MD; Muhammad Shafi, MD; Saira Imran, MD
Author and Funding Information

Memorial Hospital of Rhode Island, Pawtucket, RI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):338A. doi:10.1016/j.chest.2016.08.351
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SESSION TITLE: Miscellaneous Critical Care

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Intraosseous access has been successfully used since 1940s. There is proven equivalence in effectiveness of IO access when compared to central and peripheral IV access in multiple observational studies. Despite these data, IO access has fallen out of favor since its initial use. Most medical school and residency program curricula lack training in this procedure which results in its under utilization especially in emergent settings. A study in European journal of medicine demonstrated that with the use of multiple teaching modalities including lectures, videos and workshops, the operator confidence rate of close to 100% can be achieved. Based on these studies we conducted a training workshop for internal medicine residents for obtaining IO access.

METHODS: Two questionnaires were devised to evaluate residents’ knowledge about obtaining intraosseous access. These included basic questions about appropriate site, apparatus, indications, contraindications and technique for IO placement. A two hour workshop was arranged with the help of critical care faculty at a university affiliated community based internal medicine residency program. 11 residents took part in the workshop. All participants filled out a pre workshop questionnaires. The participants also placed IO access in mannequins before the workshop and their performance was timed. This was followed by a didactic session that included evidence based information about IO access. Participants were also informed about appropriate apparatus, landmarks, techniques etc. Common misconceptions about the severity of pain, risk of infection and difficulty in performing IO line were also addressed. We also included a video aid for demonstrating administration of IO access. After the workshop all participants were timed again as they repeated the placement of IO access on mannequins. A different questionnaire that tested similar knowledge base was filled out by all participants after the workshop.

RESULTS: There was a marked improvement in correctly answered questions in the post workshop survey. The correctly answered questions about recognition of contraindications increased from 47% to 85%. There was a similar increase from 40% to 85% in correctly answered questions regarding appropriate anatomy. Questions about appropriate site and apparatus showed improvement from 45% to 100%. The average time required to obtain an intraosseous access improved from 74.8 seconds to 48 seconds.

CONCLUSIONS: Intraosseous access has fallen out of favor in modern day medicine. Lack of training, familiarity or skills are likely reasons for reluctance in physicians. Although multiple studies and case series support that IO is at least as useful if not superior to central line in gaining vascular access especially in critical care settings. More studies are needed to compare IO and central venous accesses in emergent settings.

CLINICAL IMPLICATIONS: This study demonstrates that learning sessions including hands on experience with the help of videos and lectures will increase the procedural confidence for the use of IO. This study also indicates possible need of inclusion of simulated training for IO access in training curriculums for internal medicine residency programs.

DISCLOSURE: The following authors have nothing to disclose: Omair Tahir, Muhammad Shafi, Saira Imran

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