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Avoid multiple IV sticks; Reduce risk of infection
With intraosseous (IO) vascular access, patients are subjected to a minimum number of sticks, so there is less chance of creating a portal for infection, says Sean Hall, an ED nurse at Desert Island Hospital in Bar Harbor, ME. "The time which can be saved by using these devices can be lifesaving in a critical patient," he says.
A new clinical guideline recommends IO access as an alternative to intravenous (IV) use in many settings. (see reference). Hall says that in his ED, IO access is considered when two attempts of IV access have been made by two ED nurses.
"IO should only be used when access for the patient is a must if you are unable to give a dose of medication, or hydration cannot be by mouth," says Hall.
Hall recommends using lidocaine to reduce discomfort. He says there are several points which can be accessed, the tibial plateau being the most common. "Try to access the center of the plateau," he recommends. "In my own personal experience, this causes less discomfort for the patient during the infusion."
Desert Island Hospital's ED nurses train frequently on the device initially, says Hall, with refreshers every six months. "Staff with frequent training will become more willing to use this technology, and not waste critical time looking for a substandard IV site," says Hall.
Hall says that in his ED, IO use is included in policies for therapeutic hypothermia, cardiac arrest, and sepsis. "By integrating this device into training sessions for each of these policies, it keeps its use fresh in the mind of staff," he says.
Teri Campbell, BSN, RN, CEN, CFRN, PHRN, an emergency nurse who participated in the Consortium on Intraosseous Vascular Access in Healthcare Practice, and a consultant for the Vidacare Corporation, manufacturer of the EZ-IO® Intraosseous Infusion System, notes that IO access doesn't carry the many risks of central lines, and allows nurses to treat patients immediately.
Campbell notes that the 2010 Advanced Cardiac Life Support and Pediatric Advanced Life Support guidelines from the American Heart Association recommend IO access over central lines for immediate vascular access.
"IO access is a safe and fast option, as opposed to prolonged, repeated attempts at peripheral access or the risks associated with central lines," Campbell says. "It provides a very rapid route for infusion of medications, fluids and blood or blood products." (See clinical tip on IO use for patients who need a central line, below.)
For more information on intraosseous access in the ED, contact:
Teri Campbell, RN, BSN, CEN, CFRN, Clinical Specialist. E-mail: firstname.lastname@example.org
Sean Hall, RN/Paramedic/CCT, Emergency Department, Mount Desert Island Hospital, Bar Harbor, ME. E-mail: sean.hall@MDIhospital.org.
Use IO as "bridge" for central lines
If your patient needs a central line but doesn't have time to wait, IO "is a safe and efficient bridge" says Teri Campbell, BSN, RN, CEN, CFRN, PHRN, an emergency nurse who participated in the Consortium on Intraosseous Vascular Access in Healthcare Practice. This is also true for patients who would be receiving a central line solely for vascular access, she adds. "IO is a safer and faster route for the patient," she says.