Intraosseous access can be taught to medical students using the four-step approach

Monika Afzali,Tobias Stenbjerg Lyngeraa,Sandra Viggers,Ask Daffy Kvisselgaard

doi:10.1186/s12909-017-0882-7

Abstract

BackgroundThe intraosseous (IO) access is an alternative route for vascular access when peripheral intravascular catheterization cannot be obtained. In Denmark the IO access is reported as infrequently trained and used. The aim of this pilot study was to investigate if medical students can obtain competencies in IO access when taught by a modified Walker and Peyton’s four-step approach.MethodsNineteen students attended a human cadaver course in emergency procedures. A lecture was followed by a workshop. Fifteen students were presented with a case where IO access was indicated and their performance was evaluated by an objective structured clinical examination (OSCE) and rated using a weighted checklist. To evaluate the validity of the checklist, three raters rated performance and Cohen’s kappa was performed to assess inter-rater reliability (IRR). To examine the strength of the overall IRR, Randolph’s free-marginal multi rater kappa was used.ResultsA maximum score of 15 points was obtained by nine (60%) of the participants and two participants (13%) scored 13 points with all three raters. Only one participant failed more than one item on the checklist. The expert rater rated lower with a mean score of 14.2 versus the non-expert raters with mean 14.6 and 14.3. The overall IRR calculated with Randolph’s free-marginal multi rater kappa was 0.71.ConclusionThe essentials of the IO access procedure can be taught to medical students using a modified version of the Walker and Peyton’s four-step approach and the checklist used was found reliable.

Highlights

The intraosseous (IO) access is an alternative route for vascular access when peripheral intravascular catheterization cannot be obtained
The American Heart Association (AHA) and the European Resuscitation Council (ERC) both recommend the use of IO access in cardiac arrest if peripheral venous catheter (PVC) is not accessible [15, 16]
Most medical students and junior doctors have limited experience with the IO devices and a lack of introduction and training is a possible reason for the limited use in the Danish Emergency department (ED). The aim of this pilot study was to investigate if medical students can obtain competencies in IO needle insertion in human cadavers when taught by a modified Walker and Peyton’s four-step approach evaluated by an objective structured clinical examination (OSCE)

Summary

Introduction

The intraosseous (IO) access is an alternative route for vascular access when peripheral intravascular catheterization cannot be obtained. In Denmark the IO access is reported as infrequently trained and used. The aim of this pilot study was to investigate if medical students can obtain competencies in IO access when taught by a modified Walker and Peyton’s four-step approach. Central venous catheter (CVC) and intraosseous (IO) cannulation can be used as an alternative to obtain vascular access in critically ill patients. These methods are suitable for the administration of fluids, blood products, The American Heart Association (AHA) and the European Resuscitation Council (ERC) both recommend the use of IO access in cardiac arrest if PVC is not accessible [15, 16]. There are no absolute contraindications for establishing the IO access as it is used on vital indication and complications such as infection and compartment syndrome are rare [3, 6,7,8, 18,19,20]

Methods

Results

Discussion

Conclusion