Use of a Battery-Operated Needle Driver for Intraosseous Access by Novice Users: Skill Acquisition With Cadavers
Received 4 May 2009; accepted 1 June 2009. published online 30 July 2009.
Study objectives
We determine skill acquisition and performance by using a battery-operated, intraosseous needle driver in cadavers.
Methods
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).
Results
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.
Conclusion
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.
aAlbert Einstein Medical Center, Department of Emergency Medicine, Philadelphia, PA
bHospital of the University of Pennsylvania, Department of Emergency Medicine, Philadelphia, PA
cUniversity of Maryland Medical Center, Department of Emergency Medicine, Baltimore, MD
Address for correspondence: Richard M. Levitan, MD, Albert Einstein Medical Center, Department of Emergency Medicine, 5501 Old York Road, Philadelphia, PA 19141; Fax 610-341-1866
Supervising editor: Kathy J. Rinnert, MD, MPH
Author contributions: RML conceived the study, designed the trial, and obtained equipment. RML, CDB, and KHB collaborated on the article and were responsible for statistical analysis. RML and CDB collaborated on background research and were responsible for conclusions. CDB was the principal investigator. CDB, TAS, and DAN collected data. TAS, DAN, and KHB were responsible for quality control. JTP was responsible for laboratory and equipment management. JTP and KHB were responsible for general oversight. RML takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. EZ-IO needle drivers and needles were supplied by the manufacturer, Vidacare, Inc., free of charge. No representative of Vidacare participated in the study in any way or reviewed the study data or article.
ABSTRACT