title: Effect of available intravenous access on accuracy and timeliness of epinephrine administration.
abstract: To evaluate the effect of available intravenous (IV) access on the accuracy and timeliness of epinephrine administration during a surprise mock severe contrast reaction.
  
  
  
  Informed consent was waived for this prospective randomized IRB-approved study. Radiology trainees with previous annual hands-on contrast reaction training (n = 46) were randomized to one of two surprise mock contrast reactions over a 23-month period: Group 1-severe laryngeal edema with IV access present (n = 27) or Group 2-severe laryngeal edema without IV access present (n = 19). Both intramuscular (IM, Epi-Pen(®)) and IV epinephrine were available in both scenarios. Time-to-treat and epinephrine administration error rates were compared by study group and by route of administration using two-tailed Student's t test or χ (2) test. Epinephrine administration errors were correlated with training experience using Pearson's correlation.
  
  
  
  Mean time to epinephrine administration was significantly faster for scenarios without IV access (Group 2: 35 ± 16 s vs. Group 1: 62 ± 49 s, p = 0.03), and for intramuscular administrations overall (IM: 42 ± 34 s vs. IV: 98 ± 46 s, p < 0.001). Epinephrine administration errors were common: (63% [17/27, Group 1] vs. 61% [11/18, Group 2], p = 1.00), had no relationship with time to most recent hands-on training (r = 0.24, p = 0.11), and were not predicted by year of post-graduate training (r = 0.04, p = 0.79).
  
  
  
  Lack of IV access is associated with a faster epinephrine administration time but no improvement in epinephrine administration error rate among radiology trainees responding to a surprise mock severe contrast reaction. Annual hands-on training appears to have little effect on epinephrine administration accuracy.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.|Division of Abdominal Imaging, Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr. B1-D502H, Ann Arbor, MI, 48109, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Masch
authors.affiliation: Division of Abdominal Imaging, Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr. B1-D502H, Ann Arbor, MI, 48109, USA.|Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., B1-D502G, Ann Arbor, MI, 48109, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Ellis
authors.affiliation: Division of Abdominal Imaging, Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr. B1-D502H, Ann Arbor, MI, 48109, USA.|Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Wang
authors.affiliation: Division of Abdominal Imaging, Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr. B1-D502H, Ann Arbor, MI, 48109, USA.|Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., B1-D502G, Ann Arbor, MI, 48109, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Cohan
authors.affiliation: Division of Abdominal Imaging, Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr. B1-D502H, Ann Arbor, MI, 48109, USA. matdaven@med.umich.edu.|Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., B1-D502G, Ann Arbor, MI, 48109, USA. matdaven@med.umich.edu.|Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., B2-A209P, Ann Arbor, MI, 48108, USA. matdaven@med.umich.edu.|Michigan Radiology Quality Collaborative, Ann Arbor, USA. matdaven@med.umich.edu.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
mesh_terms: D061605:Administration, Intravenous; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D003287:Contrast Media / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000188:drug therapy*; D004487:Edema / Q000139:chemically induced; D004503:Education, Medical, Graduate; D004837:Epinephrine / Q000008:administration & dosage*; D006801:Humans; D007818:Laryngeal Diseases / Q000139:chemically induced; D016544:Patient Simulation; D011446:Prospective Studies; D058996:Quality Improvement; D011871:Radiology / Q000193:education*; D061665:Time-to-Treatment
chemical_list: D000316:Adrenergic alpha-Agonists; D003287:Contrast Media; D004837:Epinephrine
keywords: Contrast reaction; Epinephrine; High-fidelity; Simulation; Training