Use of a Battery-Operated Needle Driver for Intraosseous Access by Novice Users: Skill Acquisition With Cadavers

Abstract

We determine skill acquisition and performance by using a battery-operated, intraosseous needle driver in cadavers. This was a prospective study of the EZ-IO, a battery-operated intraosseous needle driver (Vidacare Corp). Operators received a 5-minute presentation (with 1 insertion demonstration) and then performed 3 tibial insertions on a cadaver. Insertion time was measured from skin placement until stylet removal. Another participant recorded the time and determination of "success." Success required stable bone position and infusion of fluid without extravasation. After testing, operators completed a questionnaire including ease of use (1 to 5; 1=very difficult, 5=very easy), speed versus central line (faster, same, slower), ease of use versus a central line (easier, same, harder), and willingness to use the device in future cardiac arrest situations (yes, maybe, no). Operators included 42 emergency medicine attending physicians, 13 other physicians, 31 emergency medicine residents, and 13 nonphysicians (emergency medical services, etc). None had previous experience with the EZ-IO, and 80 of 99 (80.8%) had never placed an intraosseous needle. Two hundred eighty-nine of 297 insertions (97.3%) were successful. Success rates for the first, second, and third insertion were 96.9%, 94.9%, and 100%, respectively. Median insertion time was 6 seconds (range 3 to 25 seconds), with interquartile range 5 to 8 seconds. The mean ease of use rating was 4.8 (95% confidence interval 4.70 to 4.90). All operators subjectively rated the device faster and easier than a central line; 98 of 99 (99%) expressed willingness to use the device in a cardiac arrest. The EZ-IO requires minimal training, is easy to use, and is fast. Skill acquisition is rapid, with a high success rate on the initial insertion after a brief training session and a single demonstration.