Monday, November 10, 2014

Do You Know How to Use an Intraosseous Device (IO)?

Intraosseous 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 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 and cardiac arrest . 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) and medical-surgical units.
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 an 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.Using an ESRD) type patients. The technique of placing an intraosseous device is rather simple, involving placing the device tip into the bone matrix with a dwell time of 24 hours in order to deliver crystalloids, colloids, or medications through this device that will have an immediate effect on the patient via their systemic circulatory system via the bone marrow cavities.


Intraosseous (IO) infusions methods were researched and developed as early as the 1920’s
by C.K Drinker , a medical doctor. Doctor Drinker studied the use and effects of the IO device on the sternum and developed a theory that access to the intraosseous space should be considered a non-collapsible vein which most likely gave direct access to the central circulatory system.(Vidacare) In 1940 Dr. Henning used the IO device successfully to infuse a patient with blood into the intraosseous space of the sternum.  These types of IO devices were a part of military medical kits during WW II; however, due to the lack of organized emergency medical personnel stateside and the development of plastics after WW II, there was a decreased interest in IO infusion and thus the IO devices fell to the way side until the late 1970’s and early 1980’s. The development of enhanced plastics led to the means for medical personnel to perform what is now commonplace of initiating an intravenous (IV) catheter by which medications and fluids are infused into a patient’s vein. 

The intraosseous device was still considered an important first line treatment method for the pediatric patient especially in Pediatric Advanced Life Support (PALS). During this time period IO infusions were typically performed by using a Cook or Jamshedi needle. Both of these types of IO devices required some sort of manual screwing or boring to enter the bone matrix.

Even though most IO devices in use at the time required placement into the patient’s tibia; the first IO device approved for adult use by the United States federal Drug Administration (FDA) was the FAST1 which could be placed in the patient’s sternum. The use of IO is endorsed by the American Heart Association, European Resuscitation Council, Association for Critical Care Nurses, Emergency Nurses Association, and many more professional agencies throughout the U.S. and the rest of the world. Most if not all of these organizations recommend the IO device as the alternative to a peripheral venous access device if it cannot be rapidly established on a patient needing vascular access. Many military medical personnel including the U.S. and Israel are trained in the rapid use of an IO infusion on the battlefield. This is documented in the Emergency War Surgery and Tactical Combat Casualty Care Guidelines.

Purpose of an IO
The purpose of an IO is to obtain circulatory access in order to provide necessary intravenous fluids, medications, and/or blood products for a patient needing an intravenous catheter. However, sometimes during emergent situations a peripheral venous catheter is difficult to obtain so an alternative is needed. It is recognized nationwide that a lack of immediate vascular access can lead to unnecessary morbidity or mortality for our patients. It is imperative to establish some form of vascular access; especially in emergent situations where time is critical.

Indications for Use
The Federal Drug Administration (FDA) has approved the EZ-IO, BIG-Gun IO, and the FAST 1-IO for use in specific bones and for specific patients. The FDA states that the EZ-IO and BIG-Gun may be used for adult and pediatric patients in the proximal humerus, proximal tibia, and distal tibia. The FAST 1-IO is approved by the FDA for use in the manubrium (sternum).The FAST 1-IO is for use in patients greater than eight years of age and should be considered for use in any seriously ill or injured patient in which a PIV cannot be established in a timely manner. The anatomical landmarks to insert the IO device are the same in adults as they are for pediatric patients. The device should be inserted just medial to the tibial tuberosity, on the flat portion of the proximal tibia. Most medications, fluids, and/ or blood products that can be given intravenously may also be administered via the intraosseous route.

To Learn more about Intraosseous Devices, how they are used, how to place them visit us and take our online course Intraosseous Devices and Earn CE's.


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