interosseous access (IO)

[Christie RN2006]

ACLS now covers IO (interosseous) access in code situations... I was just wondering how many of your facilities have started using IO for codes where you can't get IV access? If you have used IO, what do you think of it and what was the outcome? Would you recommend it for hospital settings or just prehospital?

I was involved in a code situation last night where we lost the IV and no one was able to start one and the doc was unable to place a line. We ended up having to give meds via the ETT! I honestly doubt IO access would have saved the patient in that situation, but it would have been definitely useful! I could see it coming handy in some of our code situations.

[TazziRN, RN]

I've never seen it used in adults because EJs or centrals are options, but I've seen them in kids a lot. I did one in the ER not long ago, on a baby who was brought in with CPR in progress and no venous access.

[leslie :-D]

I did one in the ER not long ago, on a baby who was brought in with CPR in progress and no venous access.

how is it done?

leslie

[Mommy TeleRN, RN]

Leslie,

I'm no expert but they can manually jab it it or use a little gun like device. It can go I think into sternum or tibia. Here is one manufacturer I found. It was pics, a brochure and a video. Pretty neat stuff!

http://www.vidacare.com/Products/index_4_29.html

[leslie :-D]

thank you, nurse2b.

i can't imagine manually jabbing it but what do i know?

i wonder where the meds go?

tazz?

leslie

[Kymmi]

There is a power driver that you can put it in with however you are also able to put it in manually although that doesnt look like a way I'd like to do it. Once it is in place it functions just like a IV line/access. The meds go thru the IV tubing thru the access port.

[leslie :-D]

ahhhh, gotcha.

fascinating.

certainly seems easy enough.

i think it would be reserved for code situations.

otherwise, it seems it would be a painful alternative.

leslie

[ernurse16]

It is my understanding that sternal IO are only used on adults, not on peds. I personally don't like them and have never been in a situation where we were not able to get IV access tho I have taken care of pts that had them inserted in the field. In both instances they IO line was not in place and we had to obtain venous access anyway. The only ones that I have been trained on are the ones that are forced into the tibia... even in practice, they are creepy going through the bone

[Christie RN2006]

It is my understanding that sternal IO are only used on adults, not on peds. I personally don't like them and have never been in a situation where we were not able to get IV access tho I have taken care of pts that had them inserted in the field. In both instances they IO line was not in place and we had to obtain venous access anyway. The only ones that I have been trained on are the ones that are forced into the tibia... even in practice, they are creepy going through the bone

I am on the code team at the hospital and this was the first time we have been unable to obtain IV access... and of course it had to be on my patient too!! Someone was able to get an IV in right before they brought the pt to me, but the IV blew in the middle of the code. (I work in an ICU and they brought the pt to me looking like death warmed over and within 5 minutes the pt was coding...it wasn't pretty) His veins were crap, and like I said earlier, the doctor wasn't even able to place a central line! Like I said, I know IO access wouldn't have made a difference in the outcome of this particular code, he was too far gone by the time they brought him to the ICU, but I could definitely see how IO access could prove beneficial if used correctly in a code situation. I personally think giving meds via the ETT is a joke...

[Rach101]

Hi. I am in my final year of nursing school and we learnt about IO access and how to insert them last week.

You are right in that sternum IO access is usually only used in adults, it was designed to be used by the army because it is much easier than going into femur or other bone (a ring of small needles holds the device in place while the main needle shoots through into the marrow).

I was surprised at how easy it was to insert, even manually! Didnt require too much strength to push it through the bone and the needle was quite blunt. Apparently is you dont have a proper one it is possible to do it with a large gauged needle in an emergency situation.

Basically any meds can be passed into it, followed by a flush and enter circulation really quickly. IO access can be left in for a few days, there is a risk for infection though and...ITS EXPENSIVE! Each needle is around NZ$300!

[leslie :-D]

i'm not understanding how you can give meds through an ett...

leslie

[TazziRN, RN]

Sorry, Les, I'd gone to bed and didn't see the later posts. Can't sleep, so I'm back.

Meds through an IO go into the marrow, which is then picked up and sent out in circulation.

Meds through the ET are absorbed in the pulmonary tissues and dispersed through circulation.

IOs are not meant to be left in place longer than a few hours, because of the risk of infection. They can be left in for a couple of days but it's not recommended. IOs are last-ditch in a crash situation until line can be placed elsewhere.

It is not easy to insert an IO. I doubt nursing students can actually insert them in people, and the practice dummies are nothing like the real thing. Even in an infant it takes some pushing combined with control.