ORIGINAL ARTICLE A randomized trial comparing two intraosseous access devices in intrahospital healthcare providers with a focus on retention of knowledge, skill, and self-efficacy H. J. G. M. Derikx • B. M. Gerritse • R. Gans • N. J. M. van der Meer Received: 28 July 2013 / Accepted: 11 February 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Introduction Intraosseous access is recommended in vitally compromised patients if an intravenous access cannot be easily obtained. Intraosseous infusion can be initiated by various healthcare providers. Currently, there are two mechanical intraosseous devices approved by the U.S. Food and Drug Administration (FDA) for use in adults and children. A comparison is made in this study of the theoretical and practical performance by anesthesiologists and registered nurses of anesthesia (RNAs) in the use of the battery-powered device (device A) versus the spring-loa- ded needle device (device B). This study entailed a 12-month follow-up of knowledge, skill retention, and self- efficacy measured by standardized testing. Methods A prospective randomized trial was performed, initially comparing 15 anesthesiologists and 15 RNAs, both on using the two types of intraosseous devices. A struc- tured lecture and skill station was given with the educa- tional aids provided by the respective manufacturers. Individual knowledge and practical skills were tested at 0, 3, and 12 months after the initial course. Results There was no statistical significant difference in the retention of theoretical knowledge between RNAs and anes- thesiologists on all testing occasions. However, the self-effi- cacy of the anesthesiologists is significantly higher (p \ 0.01) than the self-efficacy of the RNAs for both devices, on any testing occasion. Insufficient skills were local disinfection (both groups, both devices) and attachment of the needle to the intravenous line (RNAs with both devices). In 33 % of all device B handlings, unsafe practice occurred. Conclusion The use of device A is safer in handling in comparison to device B at 12 months follow-up. The hypothesis that doctors are more qualified in obtaining intraosseous access has been disproven, as anesthesiolo- gists were as successful as RNAs. However, the low self- efficacy of RNAs in the use of intraosseous devices could diminish the chance of them actually using one. Keywords Intraosseous access Á Cardiopulmonary resuscitation Á In-hospital resuscitation Á Self-efficacy Á Hospital staff training Introduction The use of the intraosseous infusion to obtain vascular access has been advocated in recent years by the American Heart Association (AHA) guidelines and the European Resusci- tation Council (ERC) guidelines [1–3]. Although normally considered as an alternative route for vascular access in children, it can also be effective in adults. Intraosseous access is recommended if obtaining intravenous access is time consuming or fails or is not readily available [4–6]. Although routinely considered as an alternative route for vascular access in children, it has been proven to be effective in adults as well, especially in prehospital resus- citation [7, 8]. Intraosseous injected drugs reach adequate plasma concentrations in a time comparable with injection through a central venous catheter [1, 2, 9]. Intravenous and intraosseous administration have equal, predictable drug delivery and pharmacological effects. H. J. G. M. Derikx Department of Anesthesiology and Intensive Care, Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands B. M. Gerritse (&) Á R. Gans Á N. J. M. van der Meer Department of Cardiac Anesthesiology and Intensive Care, Amphia Hospital Breda and Oosterhout, Molengracht 21, 4818 CK Breda, The Netherlands e-mail: bgerritse@amphia.nl 123 Eur J Trauma Emerg Surg DOI 10.1007/s00068-014-0385-8