Recent discussions
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Виктория Антонова
The knowledge gaps are especially important, as they highlight areas in which information/approach could be improved around the predominant technique of UVC access. -
Виктория Антонова
Full disclosure I work for PerSys Medical the manufacturer of the NIO IO device. My background is in emergency care, critical care and vascular access. I agree with Scott DeBoer's comments. In emergency medicine and pre-hospital arrests UVC route is often not a skill that is regulary taught or maintained. Many pre-hospital EMS systems do not have UVC in their protocols. This leads to potential failed access or delayed access. I agree with the Infusion Nursing Society INS 2016 Standard 55.1 "In the event of adult or pediatric cardiac arrest, anticipate use of the IO route if intravenous access is not available or cannot be obtained quickly. Pediatric Advanced Life Support (PALS) support guidelines suggest the use of the IO route as the initial vascular access route. (II)" Per the INS 2016 guidelines Umbilical Catheters Standard 30.1 Practice criteria E." Confirm the catheter tip location by radiography, echocardiography, or ultrasonography before catheter use" Confirming catheter UVC tip prior to use outside of hospital is not obtainable in most cases. Many studies support the use of IO as a faster route than the placement of UVC without the increase of complications. Oustide of NICU theater I would highly recommend the use of IO access as the first preferred route. -
Виктория Антонова
Great document! My only comment is that It is crucial to properly train dispatchers to recognize cardiac arrest as rapidly as possible. My recommendation would be to add this as a treatment recommendation. Without proper training, the other treatment recommendations lose their impact. -
Виктория Антонова
I believe IO is more complicated since there would have to be many sizes and preterm babies are much more fragile. EV is very quickly acessible by most neonatologists independent of the type of arrest and weight/ corrected age of the newborn. -
Виктория Антонова
I think that if there are no advantages of the intraosseous route compared to the umbilical vein and most neonatologists have easier umbilical catheterization, then we should keep this preference. -
Виктория Антонова
I believe IO is more complicated since there would have to be many sizes and preterm babies are much more fragile. EV is very quickly acessible by most neonatologists independent of the type of arrest and weight/ corrected age of the newborn. -
Виктория Антонова
I would welcome a change in recommendation. My experience from many simulation-based trainings and emergency care of pediatric patients shows that the chest compressions are carried out much later when using ABC compared to CAB, since a ready-to-use bag for bag-mask ventilation is rarely directly available. In my opinion, changing the recommendations would not delay bag ventilation, but decrease the time to initiation of chest compressions. -
Виктория Антонова
Thank you for your comments. These are adult guidelines, but could probably have been marked more clearly. The BLS ILCOR treatment recommendation in 2015 was: "We suggest commencing CPR with compressions rather than ventilations (weak recommendation, very-low-quality evidence)." -
Виктория Антонова
My comments would be that (whilst I have not done a literature search or research on this) that I was always told historically that the neonatal bone is not calcified well and this increase risk of going straight through the bone, current IO needles are developed for paediatrics/adults only and drills create increased risk as you are unable to feel the pop (which is minimal on premature infant) Umbilical vein is usually very accessible and neonatal staff are usually skilled to perform the task. There are risks involved with emergency UVC also of course. My personal opinion is to continue UVC in emergency but research and equipment manufacturing could be evolved. -
Виктория Антонова
I agree. Many paediatric trainees nowadays have never been involved with UVC insertion and many complete their training with little confidence in UVC insertion and may be called upon to attend a newborn requiring immediate access. They may though have skills of IO insertion as may their adult colleagues who may be called upon to help in such a situation.