Wednesday, February 8, 2012

To Bone or not to Bone

Being a member of the INS and AVA I have learned a lot in and out of these organizations and received a lot of support from many.  On the other hand their have been instances when certain nurses laugh at topics when attempting discuss alternatives to Infusion therapy.  Infusion therapy can be done with more than just a peripheral IV catheter or a central venous access device such as a PICC line or Sub-clavian line.

These types of vascular access devices are great and have brought a lot of medical advances to the forefront; however, there is one device that is continually overlooked and even mocked; yet it has the same benefits and less complications than most if not all the other vascular access devices.

The recognition of the intraosseous (IO) vascular access device in fluid resuscitation and stabilization of patients has been underrated for quite some time. Intravenous therapy alone has made significant strides in the past forty years. The need to administer a wide variety of fluids and medications in to a patient and affect their circulatory system is critical in the resuscitation of patients in an emergent situation regardless of their underlying disease process. Rapid vascular access is required for many conditions to include but not limited to hypovolemic shock, trauma, anaphylactic shock, cardiac arrest and many more conditions.

There have been several “leading national and international organizations” that have published position statements as well as performed research studies to advance the cause of the IO. The IO has served to change the standard of care in the emergency room in regards to the quick need for vascular access, but also is making strides to the way we care for patients in the intensive care units (ICU’s) medical-surgical units, and beyond.
Among the leading organizations who state that the IO can play a significant role in the care of patients in need of resuscitation is the American Heart Association (AHA), addressing vascular access in cardiac arrest patients1, the Infusion Nurses Society (INS)2, the Emergency Nurses Association (ENA)3 and the American Association of Critical-Care Nurses (AACN) all endorsing the INS position statement.2 The intraosseous device is recognized by these professional organizations due to the significant time savings that patients benefit from in emergency situation as well as the minimal complications in relation to central venous catheters and peripheral venous catheters.
The Intraosseous device allows healthcare professionals to decrease the time required to achieve access as well as administer necessary intravenous fluids and medications needed for resuscitation or stabilization of a patient throughout the different areas of nursing. The AHA came to the conclusion that a peripheral intravenous catheter (PIV) and an intraosseous device (IO) can administer equally and predictably the same pharmacological effects and in fact the IO device has a direct correlation to the central venous system and fluids and or medications can be sent to the central venous system within seconds not minutes.

To learn more about the IO devices, uses, and complications visit us at Central Valley Medical and Pedagogy to learn more.

1. American Heart Association (AHA).
2. Infusion Nurses Society (INS).
3. Emergency Nurses Association (ENA)
4. Vidacare Corporation. EZ-IO.
5. Brown, Philips, Campbell, Miller, Proehl, and Youngberg. "Recommendations for the use of Intraosseous Vascular Access for Emergent and Non-Emergent Situations…." Journal of Infusion Nursing. 36.6 (2010): Print.
6. Waismed. Big-Gun.
7. Pyng Medical. Fast1.
8. Von Hoff DD, Kuhn JG, Burris HA, Miller LJ. Does intraosseous equal intravenous? A pharmacokinetic study Am J Emerg Med. 2008;26:31-8.
9. Phillips L, Proehl J, Brown L, et al. Recommendations for the use of intraosseous vascular access for emergent and nonemergent situations in various health care settings: a consensus paper. 2010. J Inf Nurs. 33:346-51.