Article

Comparison of Umbilical Venous and Intraosseous Access During Simulated Neonatal Resuscitation

Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California 94304, USA.
PEDIATRICS (Impact Factor: 5.3). 09/2011; 128(4):e954-8. DOI: 10.1542/peds.2011-0657
Source: PubMed

ABSTRACT Emergent umbilical venous catheter (UVC) placement for persistent bradycardia in the delivery room is a rare occurrence that requires significant skill and involves space constraints. Placement of an intraosseous needle (ION) in neonates has been well described. The ION is already used in the pediatric population and is placed at an anatomic location distant from where chest compressions are performed. In this study we compared time to placement, errors in placement, and perceived ease of use for UVCs and IONs in a simulated delivery room.
Forty health care providers were recruited. Subjects were shown an instructional video of both techniques and allowed to practice placement. Subjects participated in 2 simulated neonatal resuscitations requiring intravenous epinephrine. In 1 scenario they were required to place a UVC and in the other an ION. Scenarios were recorded for later analysis of placement time and error rate. Subjects were surveyed regarding the perceived level of difficulty of each technique.
The average time required for ION placement was 46 seconds faster than for UVC placement (P < .001). There was no significant difference in the number of errors between UVC and ION placement or in perceived ease of use.
In a simulated delivery room setting, ION placement can be performed more quickly than UVC insertion without any difference in technical error rate or perceived ease of use. ION insertion should be considered when rapid intravenous access is required in the neonate at the time of birth, especially by health care professionals who do not routinely place UVCs.

0 Followers
 · 
99 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Epinephrine remains the primary vasopressor for neonatal resuscitation complicated by asystole or prolonged bradycardia not responsive to adequate ventilation and chest compressions. Epinephrine increases coronary perfusion pressure primarily through peripheral vasoconstriction. Current guidelines recommend intravenous epinephrine administration (0.01-0.03 mg/kg). Endotracheal epinephrine administration results in unpredictable absorption. High-dose intravenous epinephrine poses additional risks and does not result in better long-term survival. Vasopressin has been considered an alternative to epinephrine in adults, but there is insufficient evidence to recommend its use in newborn infants. Future research will focus on the best sequence for epinephrine administration and chest compressions.
    Clinics in perinatology 12/2012; 39(4):843-55. DOI:10.1016/j.clp.2012.09.005 · 2.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although seldom needed, the short list of medications used for delivery room resuscitation of the newborn includes epinephrine and volume expanders. Naloxone, sodium bicarbonate and the use of other vasopressors are no longer considered helpful during acute resuscitation and are more often administered in the post-resuscitative period under special circumstances. This review examines the existing literature for the two commonly used medications in neonatal resuscitation and identifies the many knowledge gaps requiring further research.
    Seminars in Fetal and Neonatal Medicine 08/2013; 18(6). DOI:10.1016/j.siny.2013.08.001 · 3.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Formal evaluation of healthcare professionals has been accomplished primarily through assessment of the ability to recall content knowledge despite the fact that cognitive, technical and behavioral skills are all important aspects of human performance in this domain. In addition human performance is also influenced by elements that are extrinsic to the human being including the systems and subsystems with which they must interact. Rigorous assessment of human and system performance in the actual healthcare environment is extremely challenging for a number of reasons. Simulation provides a methodology by which this performance can be objectively assessed, thereby facilitating the delivery of effective, safe and efficient patient care.
    Seminars in Fetal and Neonatal Medicine 09/2013; 18(6). DOI:10.1016/j.siny.2013.08.010 · 3.13 Impact Factor
Show more