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Discussion

Code Access: Central line or IO?

When responding to codes on the floors we often need additional access quickly. I'm a newer NP in my ICU and I've asked numerous times why we don't just place a IO for quick access rather than having someone place a femoral central line. The only answer I seem to get is that we don't like to have IO access long term. But, any time I've seen a femoral line placed in a code, it's also needed to be replaced ASAP because the "sterile" process isn't. And if the patient doesn't make it through the code then we've used a central line kit rather than just the IO set. Is there an actual advantage to the central line because it can be used for something the IO can't? I think it's just one of those "that's the way we've always done it and I don't have another answer" things I've encountered. 

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    At both my current and previous facility, both academic medical centers, if emergent access was required during a code or near code situation, we always place an IO.  In most, if not all situations, an IO access can be attained more quickly than central venous femoral access.  If placed in the tibia, the provider placing it is much less likely to interfere with other members of the team engaged in the resuscitation, and if properly secured should last long enough to get you through the resuscitation.  Nor can I think of any medications or fluids that would be administered during the resuscitation that can't be administered IO. 

    When you wrote "that's the way we've always done it," I strongly suspect you're right.

    Best wishes.

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