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Barriers and Facilitators to Intraosseous Access in Adult Resuscitations When Peripheral Intravenous Access Is Not Achievable
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| Zeitschriftentitel: | Academic Emergency Medicine |
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| Personen und Körperschaften: | , , |
| In: | Academic Emergency Medicine, 21, 2014, 3, S. 250-256 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
Wiley
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| Schlagwörter: |
| Zusammenfassung: | <jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>Studies suggest that intraosseous (<jats:styled-content style="fixed-case">IO</jats:styled-content>) access is underutilized in adult resuscitations, despite recommendations from advanced trauma and cardiac life support guidelines. The objective was to determine factors associated with <jats:styled-content style="fixed-case">IO</jats:styled-content> access use by physicians during adult resuscitations when intravenous (<jats:styled-content style="fixed-case">IV</jats:styled-content>) access is not immediately achievable.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This study was an online survey among physicians purposefully recruited from various clinical care areas at three teaching hospitals. Questions were generated from the qualitative results of 20 iterative interviews, verified for internal validity, and piloted. The interview guide was based on the constructs of the Theory of Planned Behavior (<jats:styled-content style="fixed-case">TPB</jats:styled-content>), which elicits salient attitudes, social influences, and control beliefs that potentially influence intention to use <jats:styled-content style="fixed-case">IO</jats:styled-content> access. Recruitment took place in September 2012 until reaching more than 100% of the required sample size (<jats:italic>n</jats:italic> = 200). Internal consistency was measured using Cronbach's alpha, and the effect of <jats:styled-content style="fixed-case">TPB</jats:styled-content> constructs and specific beliefs were assessed with regression analyses.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>For the 205 respondents, the mean age was 35 years (range = 20 to 66 years), and 53.3% were male. Participants’ departmental affiliations were 50.3% emergency medicine (<jats:styled-content style="fixed-case">EM</jats:styled-content>), 16.9% internal medicine, 14.9% anesthesia, 10.8% general surgery, and 7.2% critical care. Residents comprised 60.7% of the sample, and 39.3% were attending physicians. Median intention to use <jats:styled-content style="fixed-case">IO</jats:styled-content> access when <jats:styled-content style="fixed-case">IV</jats:styled-content> is not immediately achievable was 4.67 (interquartile range [<jats:styled-content style="fixed-case">IQR</jats:styled-content>] = 4 to 5) out of 5 (5 highest) and predicted by the following <jats:styled-content style="fixed-case">TPB</jats:styled-content> constructs: attitudes (AdjCoefficients = 0.504; 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>] = 0.334 to 0.673), social influences (AdjCoefficients = 0.285; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 0.172 to 0.398), and control beliefs (AdjCoefficients 0.217; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 0.113 to 0.320). Physicians were more likely to use <jats:styled-content style="fixed-case">IO</jats:styled-content> access if they believed that it provided rapid vascular access for delivering large volumes of fluids, could prevent delays in care, and was associated with a low complication rate. Conversely, the perception that nurses are not familiar or supportive of <jats:styled-content style="fixed-case">IO</jats:styled-content> access and a lack of physician confidence regarding the appropriate indications for <jats:styled-content style="fixed-case">IO</jats:styled-content> access were barriers to use.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These data are an important step in the knowledge‐to‐action process, as they identify specific factors associated with physician use of <jats:styled-content style="fixed-case">IO</jats:styled-content> access. Interventions addressing these actionable facilitators and barriers are likely to have a positive effect on increasing the appropriate physician use of this potentially life‐saving technique in adult patients requiring emergent vascular access.</jats:p></jats:sec> |
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| Umfang: | 250-256 |
| ISSN: |
1069-6563
1553-2712 |
| DOI: | 10.1111/acem.12329 |