Page 28 - JSOM Winter 2024

TABLE 3 Comparison of First Attempt Peripheral Intravenous (PIV) exacerbated by poor familiarity. Supervising leaders and train-
Access Success ers should note this troubling pattern and ensure device fa-
First attempt PIV access success, Odds miliarity given the high-stakes nature of the FWB donation
Technique no. (%) Ratio P value and resuscitation procedures. It also warrants future study to
SLT 11 (48) 0.3 0.037 determine if the Jelco ProtectIV Plus or similarly unique IV
SST 18 (78) 3.9 devices demonstrate a generally decreased rate of insertion
SLT = saline lock technique; SST = straight stick technique. success compared with the Safelet Cath.
FIGURE 4 Comparison of the Jelco ProtectIV Plus angiocatheter
TABLE 4 Pre- and Post-participation Self-Efficacy Scores (TOP) and Safelet Cath (BOTTOM).
n Median (IQR) P value
On a 0–100 scale how confident are you in your ability to gain
venous access and collect a FWB donation with an 18-gauge
saline lock?
Pre participation 22 80.0 (72.5–90.0) 0.030
Post participation 22 90.0 (72.5–100.0)
On a 0–100 scale how confident are you in your ability to gain
venous access and collect a FWB donation with the 16-gauge
needle in the collection kit?
Pre participation 22 70.0 (50.0–80.0) 0.009
Post participation 22 85.0 (62.5–97.5) Participant self-efficacy responses, both pre and post collec-
IQR = interquartile range; FWB = fresh whole blood. tion, demonstrate a need for repeated hands-on training, with
over 63% of respondents reporting pre-participation confi-
little on the procedure itself. Consequently, the limited prior dence scores of 70 or lower for their ability to successfully
research evaluating IV access success among comparable obtain SST access and complete FWB donation. Schauer et al.
medic populations restricts the optimal comparison of our noted that most study participants desired quarterly sustain-
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findings. The minimum transfusable volume collection times ment training for FWB collection and transfusion. Our find-
in our population are significantly longer than those recently ings similarly demonstrate medic calls for FWB sustainment
published by Schauer et al.; however, it is important to view training. Further studies on the FWB collection process are
this difference in the context of different sample populations. warranted to evaluate training and performance. To date, re-
Schauer et al. sampled a medic population ironically described searchers understudied this critical area of battlefield medicine
as “inexperienced” medics but showed grossly higher median as indicated by only one previously published study evaluating
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time in service compared with our population (48 vs. 23 mo). FWB collection by medics. Similarly, future research should
This prior sample included medics undergoing advanced train- evaluate and compare isolated performance between identical
ing in the Critical Care Flight Paramedic course, incorporating SLT and SST with identical 16-gauge sizes, as well as consider-
advanced instruction on IV access and FWB transfusion tech- ations for differences in performance between 18-gauge angio-
niques, thus depicting a sample of medics that were more ex- catheters, such as the Jelco ProtectIV Plus and Safelet Cath.
perienced, skilled, and motivated compared with the average
junior medic undergoing informal unit-based training. Our study is limited in several aspects, primarily our small
convenience sample from a single U.S. Army installation. Our
Prior comparable literature by Jin et al., assessing the use of randomization and recruitment process resulted in a dispro-
SLT during venipuncture, found similarly poor rates of first- portionate enrollment of male to female participants, with
attempt IV access success. Their 66% rate of venipuncture only 4% female participants, which could influence outcomes.
success is grossly higher than our 48% for 18-gauge angioca- Our study did not report donor population characteristics for
theter IV insertion. There are some important considerations BMI, sex, anomalous vascular anatomy, or tattoos overlying
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regarding this comparison, specifically the type of angiocath- vascular access sites. Although these are likely to be generally
eter device. Jin et al.’s study centered on a comparison of the reflective across the Force, unknown rates of these potential
common 18-gauge angiocatheter to an unfamiliar guidewire confounders could influence the study results by decreasing
device, with the latter demonstrating a success rate of only the success rate of IV access. Our selection of an 18-gauge IV
44%. While our study used an 18-gauge angiocatheter, the catheter versus a 16-gauge IV catheter for the SLT limits direct
employment of the Jelco ProtectIV Plus included in the FWB comparison of the SLT and SST, considering lumen radius im-
transfusion kits appears to likewise be an unfamiliar device to pacts on flow rates based on Poiseuille’s Law.
most medics. The Jelco ProtectIV Plus uses a mechanically dif-
ferent system of advancing the angiocatheter over the guiding Conclusions
hypodermic needle compared with the more traditional Safelet
Cath (Nipro Medical Corp., Miami, FL; Figure 4). The Jelco In this small convenience sample of U.S. Army Medics, SST
mechanism for advancement appeared to confound many of achieved significantly shorter minimum transfusable volume
the volunteers in this study per investigating team observa- collection times compared with the SLT technique for FWB
tions. Therefore, while Jin et al. found significantly higher donations. Given the current limited literature, the SST should
venipuncture success with the traditional 18-gauge angioca- remain the primary access method for FWB collection.
theter, the more apt comparison may be to their ‘unfamiliar’
guidewire device, in which medics exhibited a 44% success Author Contributions
rate compared to the 48% found in this study. This demon- DKR and BMC conceived the study concept. All authors
strates an overall trend of poor performance with IV access, participated in data collection. DKR and BMC analyzed the

26 | JSOM Volume 24, Edition 4 / Winter 2024