Does Technique Matter? A Comparison of Fresh Whole Blood Donation Venous Access Techniques for Time and Success.

Background: Fresh whole blood (FWB) is essential for hemorrhagic shock resuscitation, but little literature evaluates medics ability to obtain intravenous (IV) access. Options for IV access include a 16-gauge hypodermic needle attached to the FWB collection bag (straight stick technique [SST]) and an 18-gauge angiocatheter with a saline lock (saline lock technique [SLT]), which may improve access given its confirmatory flash chamber and medic familiarity.

Methods: In a prospective, randomized, crossover study, a convenience sample of U.S. Army medics performing FWB transfusion training initiated IV access with SST or SLT for FWB collection to achieve the minimum transfusable volume of 527g. The primary outcome was seconds to achieve minimum transfusable volume. Secondary outcomes included first-attempt IV access success and end-user feedback.

Results: Eighteen medics demonstrated a shorter median time to reach the minimum transfusable volume with SST (819.36 [IQR 594.40-952.30] sec) compared with SLT (1148.43 [IQR 890.90-1643.70] sec, P=.002). No sequence or period effects occurred. Compared with SLT, SST demonstrated higher first-attempt IV access success (18, 78% versus 11, 48%; P=.037). Accordingly, most medics reported SLT would perform worse than SST for FWB collection and IV access in tactical environments.

Conclusions: Medics achieved minimum transfusable volume faster and higher first-attempt IV access success with SST than SLT. Future studies should compare a 16-gauge SLT and SST, and further evaluate IV access techniques for improved evaluation of medic skills.