Competence in intraosseous device use
Abstract:
Introduction: Intraosseous access is a critical emergency procedure for rapid vascular access when peripheral intravenous insertion fails. Despite endorsement in emergency care guidelines, intraosseous use among clinicians remains limited, often due to inadequate exposure and procedural confidence. This quality improvement project evaluated the effectiveness of a low-cost, three-dimensional -printed simulation-based training intervention on emergency clinicians’ intraosseous knowledge, technical proficiency, attitudes, and clinical utilization.
Methods: A quasi-experimental, single-group pretest-posttest-follow-up design was implemented in a Midwestern community hospital. A total of 22 emergency clinicians completed a 3-phase “Crawl-Walk-Run” training program using anatomically realistic, three-dimensional-printed tibia/humerus intraosseous task trainers. Outcomes were assessed using the validated Intraosseous Training and Readiness Assessment in Nursing instrument and retrospective electronic medical record audits of nurse-initiated intraosseous insertions.
Results: Statistically significant improvements were observed in intraosseous knowledge (P < .001, g = 1.31) and technical skills (P < .001, g = 1.23), with sustained gains at 3-month follow-up. Confidence increased immediately post-training (P < .001) but declined modestly over time (P = .43). Electronic medical record review identified 5 successful nurse-initiated IO insertions within 3 months following the intervention, all achieving first-pass success, compared with 0 in the previous year comparison period.
Discussion: A low-cost, three-dimensional-printed simulation program significantly improved emergency clinicians’ intraosseous knowledge, skill proficiency, and short-term clinical utilization. These findings support three-dimensional-printed simulation as a sustainable educational strategy to enhance readiness for high-acuity, low-occurrence procedures in emergency nursing practice.
Reference:
Tighe C, Norder-Brandli C, Brauninger J, Andrews S, Kennedy J. Implementing a Three-Dimensional-Printed Simulation Program to Improve Emergency Nurse Competence in Intraosseous Device Use: A Quality Improvement Initiative. J Emerg Nurs. 2026 Jul 31:S0099-1767(26)00210-2. doi: 10.1016/j.jen.2026.06.012. Epub ahead of print. PMID: 42541500.