Recommendations for the Use of Intraosseous Vascular Access for Emergent and Nonemergent Situations in Various Healthcare 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, 1 American Heart Association American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: management of cardiac arrest. Circulation. 2005; : IV-58–IV-66 Google Scholar the International Committee on Resuscitation (ILCOR), 2 International Liaison Committee on Resuscitation (ILCOR) International consensus of cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: advanced life support. Resuscitation. 2005; 67: 213-247 PubMed Google Scholar the European Resuscitation Council, 3 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 (INS), 4 Infusion Nurses Society [position paper] The role of the registered nurse in the insertion of intraosseous access devices. J Infus Nurs. 2009; 32: 187-188 Crossref PubMed Scopus (11) Google Scholar the National Association of EMS Physicians (NAEMSP), 5 Fowler R Gallagher JD Isaacs MS et al. [resource document to the NAEMSP position statement]. The role of intraosseous vascular access in the out-of-hospital environment. Prehosp Emerg Care. 2007; 11: 63-66 Crossref PubMed Scopus (92) Google Scholar with the Emergency Nurses Association (ENA) and the American Association of Critical-Care Nurses (AACN) endorsing the INS position paper. 6 Emergency Nurses Association ENA-supported statements. http://www.ena.org Google Scholar , 7 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 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 administration have equal, predictable drug delivery and pharmacologic effects. Both AHA and European Resuscitation Council guidelines state that IO access should be the first alternative to failed IV access. 1 American Heart Association American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: management of cardiac arrest. Circulation. 2005; : IV-58–IV-66 Google Scholar , 2 International Liaison Committee on Resuscitation (ILCOR) International consensus of cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: advanced life support. Resuscitation. 2005; 67: 213-247 PubMed Google Scholar Lynn Phillips, Infusion Nurses Society and Consortium Chair. Lucinda Brown, Society of Pediatric Nurses. Teri Campbell, Air and Transport Nurses Association. Julie Miller, American Association of Critical-Care Nurses. Jean Proehl, Emergency Nurses Association. Barbara Youngberg, Visiting Professor of Health Law and Policy, Beazley Institute for Health Law and Policy, Loyola University Chicago College of Law.