Abstract
BackgroundVenous 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.MethodsAn 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.ResultsWe 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.ConclusionsUVC 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.
Highlights
Venous access during neonatal emergencies in the delivery room (DR) can be accomplished through an umbilical venous catheter (UVC) or an intraosseous (IO) access
50% of respondents stated they had never applied an INTRAOSSEOUS CANNULA (IOC) by themselves and 30% had no previous experience in establishing an UVC access
In agreement with the above guidelines, for DR management 61% of neonatologists vs. 53% of non-neonatologists were in favour of UVC placement instead of an IO access for the resuscitation of a term newborn
Summary
Venous access during neonatal emergencies in the delivery room (DR) can be accomplished through an umbilical venous catheter (UVC) or an intraosseous (IO) access. In the crucial first postnatal minutes the establishment of a venous access is essential especially in very premature infants and term newborns with circulatory compromise. This, may be challenging and time consuming [1] and untreated arterial hypotension or persistent bradycardia may ensue [2]. The 2015 ERC (European Resuscitation Council) guidelines for newborn resuscitation recommend an umbilical venous catheter for the administration of drugs (UVC) [3]. Placing an UVC might be challenging and takes longer than an intraosseous (IO) access especially for untrained personnel [4]. If an intravenous vascular access is unsuccessful, the IO access seem to be a good alternative during resuscitation
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