Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation: A randomized crossover simulation trial

Autor: Aleksandra Gasecka, Leyla Öztürk Sönmez, Lars Konge, Jacek Smereka, Michal Pruc, Maciej Cyran, Lukasz Szarpak, Marek Malysz, Anna Drozd
Přispěvatelé: Laboratory for General Clinical Chemistry
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Resuscitation
AGP
Aerosol generating procedures

Emergency Medical Services
medicine.medical_treatment
Nurses
Manikins
0302 clinical medicine
Medical simulation
Personal protective equipment
Medicine
Single-Blind Method
Prospective Studies
Intraosseous access
Education
Nursing

Infusions
Intravenous

Child
Cross-Over Studies
IO
Intraosseous access

MD
Mean difference

General Medicine
Middle Aged
Infusions
Intraosseous

Emergency Medicine
Female
Infection
Adult
medicine.medical_specialty
IRB
Institutional Review Board

Visual analogue scale
Article
03 medical and health sciences
Humans
Cardiopulmonary resuscitation
PPE
Personal protective equipment

business.industry
CI
Confidence interval

SARS-CoV-2
Jamshidi needle
COVID-19
030208 emergency & critical care medicine
Clinical trial
Coronavirus
Intravascular access
Life support
Physical therapy
IV
Intravenous access

business
Prehospital Emergency Care
OR
Odds ratio
Zdroj: American journal of emergency medicine, 49, 189-194. W.B. Saunders Ltd
The American Journal of Emergency Medicine
ISSN: 0735-6757
Popis: Background: Prehospital emergency care of children is challenging. In the era of the COVID-19 pandemic, when medical personnel should use personal protective equipment against aerosol-generating procedures, the efficiency of medical procedures may decrease. The study objective was to evaluate the effectiveness of different intravascular access methods applied by nurses wearing biosafety Level-2 suits in simulated paediatric COVID-19 resuscitation. Methods: A prospective, randomized, crossover, single-blinded simulation trial was performed. Nursing staff attending Advanced Cardiovascular Life Support courses accredited by the American Heart Association participated in the study. A total of 65 nurses were recruited and randomly assigned to different study groups. They received standard training on intravascular access methods employing distinct devices. The participants wore biosafety Level-2 suits and performed vascular access with the following intraosseous devices: NIO-P, EZ-IO, and Jamshidi needle; intravenous (IV) access was used as a reference method. Both the order of participants and the access methods were random. Each participant performed intravascular access with each of the four methods tested. The effectiveness of the first attempt to obtain intravascular access and the following time parameters were analysed: the time between grasping the intravascular device out of the original packing until infusion line connection. The ease of the procedure was measured with a visual analogue scale (1 – easy; 10 – difficult). Results: The first attempt success rate of intravascular access by using NIO-P and EZ-IO equalled 100% and was statistically significantly higher than that with the Jamshidi needle (80.0%; p = 0.02) and with the IV method (69.2%; p = 0.005). The time required to connect the infusion line varied and amounted to 33 ± 4 s for NIO-P compared to 37 ± 6.7 s for EZ-IO (p < 0.001), 43 ± 7 s for Jamshidi (p < 0.001), and 98.5 ± 10 s for IV access (p < 0.001). The procedure was easiest in the case of NIO-P and EZ-IO (2 ± 1 points; p = 1.0) compared with Jamshidi (5 ± 3 points; p < 0.001) and IV access (7 ± 2 points; p < 0.001). Conclusion: The study provides evidence that nurses wearing biosafety Level-2 suits were able to obtain intraosseous access faster and more effectively as compared with IV access during simulated COVID-19 paediatric resuscitation. The most effective method of intravascular access was the NIO-P intraosseous device. Further clinical trials are necessary to confirm the results.
Databáze: OpenAIRE