Effect of available intravenous access on accuracy and timeliness of epinephrine administration.

Abstract

To evaluate the effect of available intravenous (IV) access on the accuracy and timeliness of epinephrine administration during a surprise mock severe contrast reaction. Informed consent was waived for this prospective randomized IRB-approved study. Radiology trainees with previous annual hands-on contrast reaction training (n=46) were randomized to one of two surprise mock contrast reactions over a 23-month period: Group 1-severe laryngeal edema with IV access present (n=27) or Group 2-severe laryngeal edema without IV access present (n=19). Both intramuscular (IM, Epi-Pen(®)) and IV epinephrine were available in both scenarios. Time-to-treat and epinephrine administration error rates were compared by study group and by route of administration using two-tailed Student's t test or χ (2) test. Epinephrine administration errors were correlated with training experience using Pearson's correlation. Mean time to epinephrine administration was significantly faster for scenarios without IV access (Group 2: 35±16s vs. Group 1: 62±49s, p=0.03), and for intramuscular administrations overall (IM: 42±34s vs. IV: 98±46s, p<0.001). Epinephrine administration errors were common: (63% [17/27, Group 1] vs. 61% [11/18, Group 2], p=1.00), had no relationship with time to most recent hands-on training (r=0.24, p=0.11), and were not predicted by year of post-graduate training (r=0.04, p=0.79). Lack of IV access is associated with a faster epinephrine administration time but no improvement in epinephrine administration error rate among radiology trainees responding to a surprise mock severe contrast reaction. Annual hands-on training appears to have little effect on epinephrine administration accuracy.