Related Experiment Video
Updated: Nov 2, 2025
Author Spotlight: Evaluating Clinicians' Adoption of Ultrasound-Guided Vascular Cannulation Through Simulation Training
Published on: August 9, 2024
Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated
Anna Drozd1, Jacek Smereka2, Michal Pruc1
1Polish Society of Disaster Medicine, Warsaw, Poland.
Insights
Nurses achieved 100% success with NIO-P and EZ-IO intraosseous devices for paediatric vascular access during simulated COVID-19 resuscitation. These methods were faster and easier than traditional IV access when wearing personal protective equipment.
Area of Science:
- Emergency Medicine
- Paediatric Critical Care
- Medical Simulation
Background:
- Prehospital paediatric emergency care presents unique challenges, exacerbated by the COVID-19 pandemic.
- Personal protective equipment (PPE) use, particularly for aerosol-generating procedures, may reduce the efficiency of medical interventions.
- Evaluating effective intravascular access methods in simulated high-risk scenarios is crucial.
Purpose of the Study:
- To assess the effectiveness of different intravascular access techniques in simulated paediatric COVID-19 resuscitation scenarios.
- To compare the success rates, procedure times, and ease of use of intraosseous devices versus intravenous access when performed by nurses in biosafety suits.
Main Methods:
- A prospective, randomized, crossover, single-blinded simulation trial involving 65 nurses.
- Participants utilized NIO-P, EZ-IO, and Jamshidi needle for intraosseous access, with standard intravenous (IV) access as a control.
- Evaluation focused on first-attempt success rates, time to infusion line connection, and perceived ease of procedure using a visual analogue scale.
Main Results:
- NIO-P and EZ-IO demonstrated 100% first-attempt success rates, significantly higher than Jamshidi needle (80.0%) and IV access (69.2%).
- Intraosseous devices, particularly NIO-P (33 ± 4 s) and EZ-IO (37 ± 6.7 s), were significantly faster than IV access (98.5 ± 10 s).
- NIO-P and EZ-IO were perceived as significantly easier to use (2 ± 1 points) compared to Jamshidi needle (5 ± 3 points) and IV access (7 ± 2 points).
Conclusions:
- Nurses in biosafety Level-2 suits can achieve intraosseous access more effectively and rapidly than IV access in simulated paediatric COVID-19 resuscitation.
- The NIO-P intraosseous device emerged as the most effective method for intravascular access in this simulated setting.
- Further clinical validation is recommended to confirm these simulation-based findings.
Background:
Prehospital emergency care of children is challenging. In the era of the COVID-19 pandemic, when medical personnel should use personal protective equipment against aerosol-generating procedures, the efficiency of medical procedures may decrease. The study objective was to evaluate the effectiveness of different intravascular access methods applied by nurses wearing biosafety Level-2 suits in simulated paediatric COVID-19 resuscitation.
Methods:
A prospective, randomized, crossover, single-blinded simulation trial was performed. Nursing staff attending Advanced Cardiovascular Life Support courses accredited by the American Heart Association participated in the study. A total of 65 nurses were recruited and randomly assigned to different study groups. They received standard training on intravascular access methods employing distinct devices. The participants wore biosafety Level-2 suits and performed vascular access with the following intraosseous devices: NIO-P, EZ-IO, and Jamshidi needle; intravenous (IV) access was used as a reference method. Both the order of participants and the access methods were random. Each participant performed intravascular access with each of the four methods tested. The effectiveness of the first attempt to obtain intravascular access and the following time parameters were analysed: the time between grasping the intravascular device out of the original packing until infusion line connection. The ease of the procedure was measured with a visual analogue scale (1 - easy; 10 - difficult).
Results:
The first attempt success rate of intravascular access by using NIO-P and EZ-IO equalled 100% and was statistically significantly higher than that with the Jamshidi needle (80.0%; p = 0.02) and with the IV method (69.2%; p = 0.005). The time required to connect the infusion line varied and amounted to 33 ± 4 s for NIO-P compared to 37 ± 6.7 s for EZ-IO (p<0.001), 43 ± 7 s for Jamshidi (p<0.001), and 98.5 ± 10 s for IV access (p<0.001). The procedure was easiest in the case of NIO-P and EZ-IO (2 ± 1 points; p=1.0) compared with Jamshidi (5 ± 3 points; p<0.001) and IV access (7 ± 2 points; p<0.001).
Conclusion:
The study provides evidence that nurses wearing biosafety Level-2 suits were able to obtain intraosseous access faster and more effectively as compared with IV access during simulated COVID-19 paediatric resuscitation. The most effective method of intravascular access was the NIO-P intraosseous device. Further clinical trials are necessary to confirm the results.
