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Effect of available intravenous access on accuracy and timeliness of epinephrine administration

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Abstract

Purpose

To evaluate the effect of available intravenous (IV) access on the accuracy and timeliness of epinephrine administration during a surprise mock severe contrast reaction.

Methods

Informed consent was waived for this prospective randomized IRB-approved study. Radiology trainees with previous annual hands-on contrast reaction training (n = 46) were randomized to one of two surprise mock contrast reactions over a 23-month period: Group 1—severe laryngeal edema with IV access present (n = 27) or Group 2—severe laryngeal edema without IV access present (n = 19). Both intramuscular (IM, Epi-Pen®) and IV epinephrine were available in both scenarios. Time-to-treat and epinephrine administration error rates were compared by study group and by route of administration using two-tailed Student’s t test or χ 2 test. Epinephrine administration errors were correlated with training experience using Pearson’s correlation.

Results

Mean time to epinephrine administration was significantly faster for scenarios without IV access (Group 2: 35 ± 16 s vs. Group 1: 62 ± 49 s, p = 0.03), and for intramuscular administrations overall (IM: 42 ± 34 s vs. IV: 98 ± 46 s, p < 0.001). Epinephrine administration errors were common: (63% [17/27, Group 1] vs. 61% [11/18, Group 2], p = 1.00), had no relationship with time to most recent hands-on training (r = 0.24, p = 0.11), and were not predicted by year of post-graduate training (r = 0.04, p = 0.79).

Conclusions

Lack of IV access is associated with a faster epinephrine administration time but no improvement in epinephrine administration error rate among radiology trainees responding to a surprise mock severe contrast reaction. Annual hands-on training appears to have little effect on epinephrine administration accuracy.

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA

    William R. Masch

  2. Division of Abdominal Imaging, Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr. B1-D502H, Ann Arbor, MI, 48109, USA

    William R. Masch, James H. Ellis, Carolyn L. Wang, Richard H. Cohan & Matthew S. Davenport

  3. Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., B1-D502G, Ann Arbor, MI, 48109, USA

    James H. Ellis, Richard H. Cohan & Matthew S. Davenport

  4. Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA

    Carolyn L. Wang

  5. Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., B2-A209P, Ann Arbor, MI, 48108, USA

    Matthew S. Davenport

  6. Michigan Radiology Quality Collaborative, Ann Arbor, USA

    Matthew S. Davenport

Authors
  1. William R. Masch
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  2. James H. Ellis
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  4. Richard H. Cohan
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Corresponding author

Correspondence to Matthew S. Davenport.

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Conflicts of Interest

William R. Masch, M.D., James H. Ellis, M.D., Carolyn L. Wang, M.D., Richard H. Cohan, M.D. have no relevant financial disclosures. Matthew S. Davenport, M.D.—book contracts with Wolters Kluwer and Elsevier; paid consultant to FDA and NCI.

Funding

There was no funding solicited or used for this study.

Informed consent

The requirement for informed consent was waived by the institutional review board (i.e., part of an educational curriculum), but subjects were allowed to decline participation.

Research involving animal and human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Masch, W.R., Ellis, J.H., Wang, C.L. et al. Effect of available intravenous access on accuracy and timeliness of epinephrine administration. Abdom Radiol 41, 1133–1141 (2016). https://doi.org/10.1007/s00261-016-0660-8

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  • DOI: https://doi.org/10.1007/s00261-016-0660-8

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