title: Structured training in intraosseous infusion to improve potentially life saving skills in pediatric emergencies - Results of an open prospective national quality development project over 3 years.
abstract: BACKGROUND
  Children in emergencies need peripheral intravenous (IV) access in order to receive drugs or fluids. The success of IV access is associated with the age of patients and fails in up to 50% of children younger than 6 years. In such situations, it is essential that physicians and paramedics have a tool and easily learnable skills with a high chance of success. According to international guidelines intraosseous (IO) access would be the next step after failed IV access. Our hypothesis was that the success rate in IO puncturing can be improved by standardizing the training; so we developed an IO workshop.
  
  
  METHODS
  Twenty-eight hospitals and ambulance services participated in an evaluation process over 3 years. IO workshops and the distribution of standardized IO sets were coordinated by the study group of the University Hospital of Berne. Any attempted or successful IO punctures were evaluated with a standardized interview.
  
  
  RESULTS
  We investigated 35 applications in 30 patients (a total of 49 punctures) between November 2001 and December 2004. IO puncture was not successful in 5 patients. The success rate depended neither on the occupation nor the experience of users. Attendance at a standardized IO workshop increased the overall success rate from 77% to 100%, which was statistically not significant (P = 0.074).
  
  
  CONCLUSIONS
  Standardized training in IO puncturing seems to improve success more than previous experience and occupation of providers. However, we could not show a significant increase in success rate after this training. Larger supranational studies are needed to show a significant impact of teaching on rarely used emergency skills.
authors.affiliation: Department of Anaesthesiology, Hospital of Fribourg, CH-3280 Meyriez-Murten, Switzerland. ch.a.pfister@bluewin.ch
authors.forename: Christoph Alexander
authors.initials: CA
authors.lastname: Pfister
authors.forename: Lars
authors.initials: L
authors.lastname: Egger
authors.forename: Beat
authors.initials: B
authors.lastname: Wirthmüller
authors.forename: Robert
authors.initials: R
authors.lastname: Greif
mesh_terms: D000465:Algorithms; D002983:Clinical Competence / Q000592:standards*; D004630:Emergencies; D004634:Emergency Medical Technicians / Q000193:education*; D004635:Emergency Medicine / Q000193:education*; D016529:Emergency Nursing / Q000193:education*; D006801:Humans; D017148:Infusions, Intraosseous / Q000592:standards*; D007318:Inservice Training / Q000379:methods*; D008020:Life Support Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011677:Punctures / Q000592:standards