Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Health Care Settings: A Consensus Paper

Abstract

In recognition of the value of intraosseous (IO) vascular access in patient resuscitation and stabilization, leading national and international organizations have published position papers that have served to change the standard of care for emergency vascular access. Among them are the American Heart Association (AHA) addressing vascular access in cardiac arrest patients ( American Heart Association, 2005a American Heart Association American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: Part 7.2: Management of cardiac arrest. Circulation. 2005; : IV 58-IV 66 Google Scholar ), the International Liaison Committee on Resuscitation ( International Liaison Committee on Resuscitation (ILCOR), 2005 International Liaison Committee on Resuscitation (ILCOR) International consensus of cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 4: Advanced life support. Resuscitation. 2005; 67: 213-247 Abstract Full Text Full Text PDF PubMed Scopus (203) Google Scholar ), the European Resuscitation Council ( European Resuscitation Council, 2005 European Resuscitation Council European Resuscitation Guidelines. Resuscitation. 2005; 6751 (Accessed July 3, 2010): 51-52http://www.erc.edu/index.php Google Scholar ), the Infusion Nurses Society ( Infusion Nurses Society, 2009 Infusion Nurses SocietyThe role of the registered nurse in the insertion of intraosseous access devices. Journal of Infusion Nursing. 2009; 32 (position paper): 187-188 Crossref PubMed Scopus (11) Google Scholar ), the National Association of EMS Physicians ( Fowler et al., 2007 Fowler R. Gallagher J.D. Isaacs M.S. et al. The role of intraosseous vascular access in the out-of-hospital environment (resource document to the NAEMSP position statement). Prehospital Emergency Care. 2007; 11: 63-66 Crossref PubMed Scopus (91) Google Scholar ), with the Emergency Nurses Association (ENA) and the American Association of Critical-Care Nurses (AACN) endorsing the INS position paper ( American Association of Critical Care Nurses American Association of Critical Care Nurses American Association of Critical-Care Nurses endorses nurses' expanded role in use of IO access devices. http://www.aacn.org/WD/PressRoom Google Scholar , Emergency Nurses Association, 2009 Emergency Nurses Association ENA supported statements Published August. http://www.ena.orgDate: 2009 Google Scholar ). These professional societies recognized that IO access may provide significant time savings that could benefit patients in emergent situations by decreasing the time required to achieve access and the time required to administer necessary fluids and medications. The AHA concluded that intravenous (IV) and IO administrations have equal, predictable drug delivery and pharmacologic effects. Both AHA and the European Resuscitation Council guidelines state that IO access should be the first alternative to failed IV access ( American Heart Association, 2005a American Heart Association American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: Part 7.2: Management of cardiac arrest. Circulation. 2005; : IV 58-IV 66 Google Scholar , International Liaison Committee on Resuscitation (ILCOR), 2005 International Liaison Committee on Resuscitation (ILCOR) International consensus of cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 4: Advanced life support. Resuscitation. 2005; 67: 213-247 Abstract Full Text Full Text PDF PubMed Scopus (203) Google Scholar ).