IV access in bleeding trauma patients: a performance review.
BACKGROUND
Exsanguinating haemorrhage is a leading cause of death in severely injured trauma patients. Management includes achieving haemostasis, replacing lost intravascular volume with fluids and blood, and treating coagulopathy. The provision of fluids and blood products is contingent on obtaining adequate vascular access to the patient's venous system. We sought to examine the nature and timing of achieving adequate intravenous (IV) access in trauma patients requiring uncrossmatched blood in the trauma bay.


METHODS
We performed a retrospective chart review of all patients admitted to our trauma centre from 2005 to 2009 who were transfused uncrossmatched blood in the trauma bay. We examined the impact of IV access on prehospital times and time to first PRBC transfusion.


RESULTS
Of 208 study patients, 168 (81%) received prehospital IV access, and the on-scene time for these patients was 5 min longer (16.1 vs 11.4, p<0.01). Time to achieving adequate IV access in those without any prehospital IVs occurred on average 21 min (6.6-30.5) after arrival to the trauma bay. A central venous catheter was placed in 92 (44%) of patients. Time to first blood transfusion correlated most strongly with time to achieving central venous access (Pearson correlation coefficient 0.94, p<0.001) as opposed to time to achieving adequate peripheral IV access (Pearson correlation coefficient 0.19, p=0.12).


CONCLUSIONS
We found that most bleeding patients received a prehospital IV; however, we also found that obtaining prehospital IVs was associated with longer EMS on-scene times and longer prehospital times. Interestingly, we found that obtaining a prehospital IV was not associated with more rapid initiation of blood product transfusion. Obtaining optimal IV access and subsequent blood transfusion in severely injured patients continues to present a challenge.
Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. Electronic address: pengels@ualberta.ca.
Paul T
PT
Engels
Edward
E
Passos
Andrew N
AN
Beckett
Jeffrey D
JD
Doyle
Homer C
HC
Tien
D000328:Adult; D001803:Blood Transfusion / Q000379:methods; D002170:Canada / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods*; D002983:Clinical Competence / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D058734:Exsanguination / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000517:prevention & control; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
Central venous catheter; Intraosseous; Intravenous; Quality indicators; Resuscitation; Trauma