Factors affecting the frequency of vascular access via intraosseous cannulation performed by paramedics in Johannesburg.

Abstract

In an emergency, the administration of fluids and medications remains a vital component of patient care. Although this is usually achieved via an intravenous line, intraosseous (IO) cannulation is accepted as a useful alternative for the administration of fluids and medications in situations where intravenous cannulation is difficult or impossible. Despite this, IO cannulation appeared to be infrequently performed by paramedics in Johannesburg (JHB). This study investigated factors that may be affecting the frequency with which IO cannulation is performed by paramedics in JHB. A qualitative design was utilized making use of one-on-one interviews with 12 purposefully selected operational paramedics from emergency medical services in JHB. The interviews were recorded and transcribed. Introspective analysis and interpretive phenomenological analysis were conducted to identify emerging themes and patterns. IO cannulation is infrequently performed by paramedics in JHB. Factors identified that reduce the likelihood of the procedure being performed included "Negative Perceptions Relating to the Procedure"; "Practitioner Success at Intravenous Cannulation"; "Close Proximity of Hospitals"; "Patient Profile, Presentation and Case Load"; "Lack of Appropriate Equipment"; and "Lack of Appropriate Training." Procedures are more inclined to move from the in-hospital to the prehospital environment if they are seen to be commonly performed, safe and effective. It would appear that paramedics infrequently witness IO cannulation being performed in emergency departments. This together with a lack of appropriate equipment, training and retraining including the perceived invasiveness and pain associated with the procedure appears to be dissuading paramedics from regularly performing IO cannulation.