You know the drill: Intraosseous vascular access as an option in cardiac arrests in inpatient psychiatric units
AIM: Should intraosseous vascular access (IOA) be an option available to medics during cardiac arrests in inpatient psychiatric units at Derbyshire Healthcare NHS Foundation Trust? BACKGROUND: Cardiac arrests in inpatient units are rare, serious events that require rapid and efficient response. An important aspect is gaining vascular access quickly, commonly by intravenous access (IVA). Psychiatrists and some junior doctors may not have performed IVA for a number of years as it is not routine in practice. A GMC literature review regarding ‘skills fade’ suggested there is an argument for retraining in clinical techniques following 2-3years of non-use. Evidence shows that positive short-term (return of spontaneous circulation (ROSC)) and long-term (neurological) outcomes following adrenaline administration in out-of-hospital arrests are time dependant. IOA shows greater first-attempt success and quicker time to vascular access when compared to IVA. IOA was non-inferior to IVA in gaining ROSC in out-of-hospital arrests.
METHOD: A survey was conducted in November 2017 to gain information on intravenous competence and confidence as well as regarding IOA. Response rate- 20%. The results of the survey and literature evidence were presented to the Trust Physical Care Committee. RESULTS: 23.1% consultants, 7.7% higher trainees, 30.8% psychiatry core trainees, 11.5% GPVTS, 11.5% foundation trainees and 15.4% other doctor. (1) When was the last time you successfully gained IVA? <6months 23.1%; 6months-1year 3.6%; 1-3years 34.6%; 3-5years 7.7%; 5-10years 15.4%; >10years 15.4%. (2) Would you feel competent gaining IVA now? Yes 76.9%; No 23.1%. (3) Would you feel confident gaining IVA now? Yes 57.7%; No 42.3%. (4) Have you any experience of using IOA? No 26.9%; Yes (seen) 34.6%; Yes (trained) 46.2%; Yes (performed) 3.9%; Other19.2%. CONCLUSIONS: The results show that almost three-quarters of respondents hadn’t gained IVA in over a year, with over a third not having done so in over 3 years, increasing the risk of skills fade. More respondents felt competent than felt confident in gaining IVA. This is consistent with evidence showing that theoretical knowledge of clinical skills decays at a slower rate than practical application. Almost three-quarters had some, varying experience of IOA. The Physical Care Committee supported the use of intraosseous access kits as an option in cardiac arrest to gain access more quickly. Annual intraosseous training to combat skills-fade will also be introduced. Once active, the use and training of intraosseous access at the trust will be audited and evaluated.
