Hubble M W, Trigg D C
Emergency Medical Care Program, Western Carolina University, Cullowhee, North Carolina 28723, USA.
Prehosp Emerg Care. 2001 Apr-Jun;5(2):181-9. doi: 10.1080/10903120190940100.
To compare the success rates, complication rates, and times required for paramedic students to perform saphenous vein cutdown and adult intraosseous infusion using the bone injection gun (BIG).
This was a prospective, randomized crossover study of 13 senior-level students in a baccalaureate degree paramedic program. Study subjects were instructed in adult intraosseous and saphenous vein cutdown techniques through lecture and laboratory exercises and then randomized into two groups. Group 1 performed saphenous vein cutdown at the ankle, followed by intraosseous infusion using the BIG. Group 2 performed the same procedures but in reverse order. All procedures were performed on preserved cadavers and videotaped. Using a standardized scoring sheet, the authors evaluated the study subjects at the time of the procedures to determine success rates, errors, and complications. Videotapes were later reviewed to verify the time required to complete the procedures.
The normalized mean procedure scores were 96.15 (SD 4.28) and 83.83 (SD 15.52) for the intraosseous infusion and saphenous vein cutdown procedures, respectively (95% CI for difference in means, -12.34 to -1.3; p = 0.020). Success rates for establishing venous access were higher for the intraosseous route (92.3%) than the cutdown technique (69.2%), but did not achieve statistical significance (p = 0.250). The times required to initiate fluid flow were 3.91 minutes (SD 0.82) by the intraosseous route and 7.57 minutes (SD 1.80) by venous cutdown (95% CI for difference in means, 2.43 to 5.55; p = 0.000). One critical error and 11 noncritical errors were encountered during the intraosseous procedure, compared with ten critical errors and 29 noncritical errors during the cutdown procedure ( p = 0.195).
In a group of inexperienced paramedic students working on a preserved human cadaver model, intravenous access was gained more rapidly, with a higher success rate, and with fewer complications using the bone injection gun than by the saphenous vein cutdown procedure. Further study is needed to evaluate these procedures in the field setting and to compare their feasibility with other alternative venous access techniques such as femoral, external jugular, and central venous cannulation.
比较护理专业学生使用骨内注射枪（BIG）进行大隐静脉切开术和成人骨内输液的成功率、并发症发生率及所需时间。
这是一项对13名护理学学士学位护理专业高年级学生进行的前瞻性随机交叉研究。通过讲座和实验室练习，向研究对象讲授成人骨内和大隐静脉切开技术，然后随机分为两组。第1组在脚踝处进行大隐静脉切开术，随后使用BIG进行骨内输液。第2组进行相同的操作，但顺序相反。所有操作均在防腐尸体上进行并录像。作者使用标准化评分表在操作时对研究对象进行评估，以确定成功率、失误情况和并发症。随后查看录像带以核实完成操作所需的时间。
骨内输液和大隐静脉切开术的标准化平均操作得分分别为96.15（标准差4.28）和83.83（标准差15.52）（均值差异的95%置信区间为 -12.34至 -1.3；p = 0.020）。骨内途径建立静脉通路的成功率（92.3%）高于切开技术（69.2%），但未达到统计学显著性（p = 0.250）。骨内途径启动液体流动所需时间为3.91分钟（标准差0.82），静脉切开为7.57分钟（标准差1.80）（均值差异的95%置信区间为2.43至5.55；p = 0.000）。骨内操作过程中出现1次严重失误和11次非严重失误，而切开操作过程中出现10次严重失误和29次非严重失误（p = 0.195）。
在一组使用防腐人体尸体模型的缺乏经验的护理专业学生中，与大隐静脉切开术相比，使用骨内注射枪进行静脉穿刺能更快获得成功，成功率更高，并发症更少。需要进一步研究以在现场环境中评估这些操作，并将其与其他替代静脉通路技术（如股静脉、颈外静脉和中心静脉置管）的可行性进行比较。
