Clinical Management of Intraosseous Access in Adults in Critical Situations for Health Professionals.

Álvaro Astasio-Picado,Claudia Aranda-Martín,Paula Cobos-Moreno,María Del Carmen Zabala-Baños,Beatriz Gómez-Martín

doi:10.3390/healthcare10020367

Álvaro Astasio-Picado, Claudia Aranda-Martín + Show 3 more

Open Access

https://doi.org/10.3390/healthcare10020367

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Abstract

There are health professionals who are unaware of the ideal management of the intraosseous route, despite the fact that it has been scientifically considered an alternative to the peripheral venous route when the patient is in critical condition. Thanks to continuous development, there has been a need to provide emergency services with materials that manage to provide satisfactory care, despite the difficulties faced by health personnel. Objectives: The objective of this systematic bibliographic review is to update the theoretical and practical knowledge and strategies for the insertion and proper management of the intraosseous route as an emergency vascular access for nursing professionals. Data sources, study eligibility criteria: The search for the articles was carried out in various scientific databases with the help of a search string (January 2015 and May 2021), which combined the keywords and Boolean operators. Study appraisal and synthesis methods: Eighteen articles were chosen after a review of 1920 database articles, following the application of the inclusion and exclusion criteria. Results: Intraosseous infusion is an effective and safe technique, which increases patient survival. Therefore, it is of crucial importance that all nursing professionals know how to handle the different intraosseous devices in situations in which it is not possible to achieve immediate peripheral venous access. Conclusions and implications of key findings: It is of great need to have devices or fast and effective alternatives that allow us to develop safe interventions by health professionals.

Highlights

Intraosseous injection (IO) is a technique indicated in life-threatening situations for both adult and pediatric patients, in which the infusion of medications or liquids cannot be delayed in time, and due to age or circulatory collapse, vascular access cannot be achieved in about 60–90 s, with a maximum of up to three puncture attempts
Authors such as Janneth R., argue that IO should only be used in situations involving a vital emergency and for a limited time, when venous access is inaccessible and it is a temporary measure until a venous line is achieved [6,11]
We found that 35.1% of EZ-IO inserts experienced poor flow and required a pressure bag

Summary

Introduction

Intraosseous injection (IO) is a technique indicated in life-threatening situations for both adult and pediatric patients, in which the infusion of medications or liquids cannot be delayed in time, and due to age or circulatory collapse, vascular access cannot be achieved in about 60–90 s, with a maximum of up to three puncture attempts. All, it is used in patients in a state of shock who need to be administered blood, crystalloids, or colloids in situations of anaphylaxis, severe burns, obesity, status epilepticus, trapped, dehydrated, multiple trauma, altered level of consciousness, etc. Nursing professionals can perform intraosseous insertion since this technique was approved and is reflected in the NIC code 2303 “Administration of intraosseous medication” by inserting a needle through the bone with the aim of administering fluids, blood, or medications [1]

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