Intraosseous access in infants-development of an anatomical training model

Med Klin Intensivmed Notfmed. 2025 Jun 19. doi: 10.1007/s00063-025-01295-4. Online ahead of print.

ABSTRACT

BACKGROUND: Safe intraosseous (i.o) access as an alternative to intravenous (i.v.) access is essential in the treatment of infants and young children in emergency medicine. However, the literature shows high misplacement rates and insufficient training opportunities for potential users. The aim of this study was to analyze malpunctures in postmortem computed tomography (CT) imaging and to develop and evaluate a realistic, cost-effective three-dimensionally (3D) printed training model for i.o. punctures in children under 2 years of age.

MATERIALS AND METHODS: The CT data from 25 deceased children under 2 years of age were retrospectively analyzed to document the frequency and type of malpunctures. Based on the findings, a three-part model was produced using filament 3D printing and silicone moulding. The realistic representation of skin, connective tissue, and bone was evaluated by 55 experienced users on a Likert scale.

RESULTS: In 40% of the punctures analyzed, there was incorrect placement, often due to inadequate anatomical assessment. The model developed was rated by the interviewees as suitable for beginner training. Suggestions for improvement mainly concerned haptic skin characteristics and the simulation of the loss of resistance after cortical penetration. Material costs for the training model were around 50 cents per puncture.

CONCLUSION: The 3D printed model offers a cost-effective, anatomically precise training option for intraosseous punctures in infants. It can contribute to the improvement of competence and safety during i.o. access, provided it is supplemented by regular training. Future enhancements should further optimize haptic skin characteristics and should provide better feedback on puncture success.

PMID:40536548 | DOI:10.1007/s00063-025-01295-4