Intraosseous is faster and easier than umbilical venous catheterization in newborn emergency vascular access models☆

Abstract 

The purpose of this study is to compare the speed and ease of establishing newborn emergency vascular access using intraosseous (IO) versus umbilical venous catheterization (UVC). The study is an experimental design. A total of 42 medical students, without prior IO and UVC experience, were recruited as study subjects. All subjects performed the UVC procedure and were randomized (by a coin flip) to perform the IO procedure in one of two models: (1) turkey bone or (2) plastic infant leg. Each subject performed an initial trial for both the IO and UVC procedures without practice (“Inexperienced attempt”) and a second trial in both procedures after practice (“Experienced attempt”), such that in total, each subject completed four attempts (two IO and two UVC). IO and UVC placement times were measured, and placement difficulty scores for IO and UVC were measured using a 10 cm visual analog scale (VAS). The averaged elapsed time to successful access was significantly shorter for the IO procedure on both the initial “inexperienced” attempt (52 versus 134 seconds, P < .001) as well as the “experienced” attempt (45 versus 95 seconds, P = .011). Procedure difficulty scores were lower in the IO procedure for both “inexperienced” and “experienced” attempts (3.5 versus 5.5, P = .001 and 2.6 versus 4.7, P < .001) as measured on a 10 cm VAS. Although UVC may be preferred by neonatologists, this model suggests that IO results in easier and more rapid vascular access in those who do not frequently perform newborn resuscitation. As such, the benefit of teaching UVC in pediatric resuscitation courses should be reconsidered. The recommended method of emergency newborn vascular access should be reconsidered pending further studies on this subject.

Keywords:  Intraosseous, umbilical vein catheterization, emergency care, resuscitation, vascular access, neonatology

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