PDF(Pubmed)
Abstract：
Introduction Intraosseous (IO) access is an alternative to peripheral intravenous access, in which a needle is inserted through the cortical bone into the medullary space using either a manual driver or an electric drill. Although studies report high success rates of IO access, failures are often attributed to incorrect site placement due to failure to adhere to anatomical landmarks. This study was designed to evaluate the ability of paramedics to locate the correct anatomic location for IO needle insertion. Methods Participants were paramedics who were recruited at Pennsylvania\'s annual statewide Emergency Medical Services (EMS) conference. After completing a demographics survey which included information about their training and practice environment, they were asked to identify which IO sites were permitted for IO placement using the EZ IO® drill and to place a sticker at those locations on a human volunteer. A transfer sheet was utilized, and the distance between the participants\' sticker and the location as marked by a physician board-certified in both Emergency Medicine and Emergency Medical Services was recorded. Descriptive statistics and t-tests were calculated from the records. Results Of 30 paramedics who participated in the study, 25 (83%) had been in practice for more than five years (range: 1-37 years), 13 (46%) reported running more than 20 calls per week, and 23 (79%) reported that they only or mostly provide 9-1-1 EMS response. Ten (36%) participants were currently certified in PHTLS, and 16 (57%) had previously been PHTLS certified. All participants reported having been trained in IO insertion. Seventeen (57%) reported having utilized an IO ≤10 times in the field, and 13 (43%) reported >10 field IO insertions. When asked to identify appropriate IO insertion sites for the EZ IO drill, 26 paramedics (90%) correctly identified both the proximal humerus and proximal tibia. The average distance from the landmark for the humeral insertion site was 5.06 cm, with a statistically significant difference in the means for those who did and did not rotate the arm internally before identifying the humeral IO insertion site (p < .01). The average distance from the landmark at the tibial insertion site was 4.13 cm. Conclusion Although a high percentage of paramedics were able to verbally identify the correct location for IO placement, fewer were able to locate the insertion site on a human volunteer. Our results suggest a need for hands-on refresher training to maintain competency at IO insertion, as it is a rarely utilized procedure in the field.
摘要：
介绍骨内(IO)通路是外周静脉通路的替代方案。其中使用手动驱动器或电钻将针穿过皮质骨插入髓腔。尽管研究报告IO访问的成功率很高，故障通常归因于由于未能坚持解剖标志而导致的不正确的部位放置。这项研究旨在评估护理人员定位IO针插入的正确解剖位置的能力。方法参与者是在宾夕法尼亚州年度全州紧急医疗服务（EMS）会议上招募的护理人员。完成人口统计调查后，其中包括有关其培训和实践环境的信息，他们被要求确定允许使用EZIO®钻头进行IO放置的IO站点，并在志愿者的这些位置上贴上贴纸。使用了转印纸，并记录参与者的标签和位置之间的距离，如医生委员会在急诊医学和急诊医疗服务认证标记。根据记录计算描述性统计和t检验。结果参与研究的30名护理人员，25（83％）已在实践超过五年（范围：1-37年），13人(46%)报告每周打20多个电话，23人(79%)报告他们仅或大部分提供9-1-1EMS响应。十名（36%）参与者目前在PHTLS认证，和16（57％）先前已通过PHTLS认证。所有参与者报告已接受IO插入培训。17人(57%)报告在该领域使用了≤10次IO，13例(43%)报告了>10个字段IO插入。当被要求为EZIO钻孔确定适当的IO插入位置时,26名护理人员（90％）正确识别了肱骨近端和胫骨近端。肱骨插入部位距标志的平均距离为5.06cm，在确定肱骨IO插入部位之前，有和没有在内部旋转手臂的人的手段有统计学上的显着差异（p<.01）。距胫骨插入部位界标的平均距离为4.13cm。结论虽然大部分护理人员能够口头确定IO放置的正确位置,能够在人类志愿者身上找到插入位点的人较少。我们的结果表明，需要进行动手进修培训，以保持IO插入的能力，因为这是一个很少在现场使用的程序。
