Hi Everyone

Whilst we have Intraosseous devices on our resuscitation trolleys the question has been raised that they are used so infrequently how do we ensure that we maintain training and competence in its use?

How have other Units dealt with this? As one of my colleagues astutely observed, training does not necessarily confer competence.

Thank you for your thoughts

Al

Hi,

we also have intraosseus device available for DR resuscitation and this is part of the regular simulation training. I agree that this does not entirely replace actual use, which is extremely rare but also depending on who is in charge of the situation and what is his/her prior experience. I recall an old study from Canada, where they showed that using it less than once in two years (the frequency may not be accurate) does not alter the proportion of successful attempts compared to those, who use it more. However, people using it more often solved more situations just making more attempts per case.

On newborns and even in fullterm babies my experience is that we too often go through the bone ending on the other side, in the muscle. While trying to prevent that, the needle will not reach the bottom and I´m happy to find I correctly reached the bonemarrow. But now I´m ending up in a new problem: The fixation stays unstable! M yguess is that the needle is too long even for fullterm babies .

Hi,

we have IO-devices on our Resuscitation trolleys as well as in the emergency backpacks for our mobile teams. We do at least 1 regular simulation training with various scenarios a year for every member of our team. But still the use of the IOs in real life very seldom occurs. To me the length of the needle seems to be a critical point as well. So as a consequence wrong positioning or difficulties in fixation is a frequent problem.

We also have these around, but very rarely used. We also simulate yearly, but rarely the use of IO-device, room for improvement there.

IMHO though, in just newborn infants, there are enough option for intra-vessel catheters. But of course also good with a last resort technology. Given one knows how to use it 🙂

On special occasion was an infant in our late GBS sepsis outbreak some years back (published here: https://pubmed.ncbi.nlm.nih.gov/30152878/). Those very sick infants were all beyond the option for umbilical catheters, and once a colleague used our IO-device, I think a life-saving choice for that particular infant.