Hlanze Keabetsoe, Swartzberg Kylen, Wells Mike
Division of Emergency Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Department of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
Afr J Emerg Med. 2025 Mar;15(1):513-517. doi: 10.1016/j.afjem.2024.11.001. Epub 2024 Dec 6.
Timely vascular access forms a necessary part of patient management in the Emergency Department (ED). Factors such as hypotension, intravenous drug use, obesity, dark skin, patients at extremes of age, and patients with multiple injuries may make peripheral intravenous cannulation difficult. The intraosseous route remains a suitable alternative for emergency circulatory access. The objectives of this study were to describe the knowledge, attitudes, and practice of doctors in the ED about the use of intraosseous access in critically ill adult patients.
A descriptive study was performed in the EDs of four hospitals in Gauteng, South Africa. Questionnaires were distributed to doctors working in the ED, including intern medical doctors, community service medical doctors, emergency medicine medical officers, emergency medicine registrars, as well as emergency medicine consultants.
Of 88 participants 64.8 % of participants had never used intraosseous access on adult patients in a resuscitation in the ED. Those who do use intraosseous access, use it 1.5 times a month, per clinician. Reasons for not using intraosseous access included: lack of equipment availability, lack of experience, and other preferable methods.
The advantages of using the intraosseous route for circulatory access include its reliability, ease of teaching, rapid use, and low complication rates. Despite sufficient knowledge of intraosseous access and training received at various courses; provider preference and other systemic barriers, lead to an overall reduction in intraosseous access being used in the clinical setting. Intraosseous access remains a cost-effective, life-saving technique for gaining circulatory access. These results can be used to create awareness regarding the availability of other alternatives for gaining circulatory access, enhancing education and training, and improve the standard of health care, particularly in resource-limited settings.
及时建立血管通路是急诊科患者管理的必要组成部分。低血压、静脉吸毒、肥胖、皮肤黝黑、年龄极端的患者以及多处受伤的患者等因素可能会使外周静脉置管变得困难。骨内通路仍然是紧急循环通路的合适替代方法。本研究的目的是描述急诊科医生对在危重症成年患者中使用骨内通路的知识、态度和实践。
在南非豪登省的四家医院的急诊科进行了一项描述性研究。向在急诊科工作的医生发放问卷，包括内科实习医生、社区服务医生、急诊科医务人员、急诊科住院医生以及急诊科顾问医生。
在88名参与者中，64.8%的参与者在急诊科对成年患者进行复苏时从未使用过骨内通路。那些确实使用骨内通路的医生，每位临床医生每月使用1.5次。不使用骨内通路的原因包括：设备不可用、缺乏经验以及其他更可取的方法。
使用骨内通路进行循环通路的优点包括其可靠性、易于教学、使用迅速和并发症发生率低。尽管对骨内通路有足够的了解并且在各种课程中接受过培训；但提供者的偏好和其他系统障碍导致临床环境中骨内通路的总体使用减少。骨内通路仍然是一种获得循环通路的经济有效、挽救生命的技术。这些结果可用于提高对获得循环通路的其他替代方法的认识、加强教育和培训，并提高医疗保健标准，特别是在资源有限的环境中。
