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.

[analee23]

We use IOs frequently in my pediatric ED during code situations. The thing that bugs me about them is that it is pretty dang easy to dislodge them! Often when the medics place them, by the time they get to us, they've infiltrated. The MAIN thing to remember is that you have to push the drugs and fluid a little slower than you would with IVs. Still works quickly, just gotta be a little more gentle! Also, takes a bit of umph to place, but once you're in, you'll know it!

Not my favorite way to administer meds, but works just the same!

[XB9S, BSN, MSN, EdD, RN, APN]

I have used IO in burns nursing for resuscitation of severely shocked patients where IV access is impossible. We used to leave them for 18 hours max and then either cannulate if the access was better or resite the IO (usually if they were this poorly they didnt survive long)

In adults we used Calcaneus and paeds we used the tibial tuberosity.

It is a fairly aggressive and very invasive technique which is why it is a resuscitation choice of access it would not be tolerated by anything other than a unconcious or very knocked off patient.

It is a useful tool and the times that I have had to use it it has been used successfully with good patient outcomes as a result. I worked in quite a rural unit and the burns patients sometimes had to travel for at least 6 hours before they arrived at the burns centre.

Here are some links that I have found useful

http://emj.bmj.com/cgi/reprint/17/1/29

http://emj.bmj.com/cgi/content/full/17/2/136

https://www.tarn.ac.uk/content/downloads/70/Intraosseous%20paper.pdf

[leslie :-D]

what size needle is used?

leslie

[XB9S, BSN, MSN, EdD, RN, APN]

what size needle is used?

leslie

Ohh now your asking, it was a while ago but I seem to remember 16gauge for kiddies and 14 for adults although this may be wrong. I will check tommorrow

[sirI, MSN, APRN, NP]

Good article from eMedicine complete with images:

http://www.emedicine.com/ped/topic3053.htm

[TazziRN, RN]

I do find IOs creepy. Effective, if properly placed, but still creepy.

Uh- huh!!

[Chaya, ASN, RN]

Haven't placed one in real life but am re-certing in ACLS currently and they just showed us a training video in the technique using a hand held drill-type device. In the film they used hospital employees as volunteers; without exception they just sat there through it, smiling and saying how painless it was. One of the volunteers even said that getting a regular IV was more painful. (Those of us watching the film, however were cringing and groaning!):chair:

[TazziRN, RN]

Painless? I don't think so!!! Otherwise why would the instructions include "Do not insert in an awake pt"????

[smk1, LPN]

thank you, nurse2b.

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

i wonder where the meds go?

tazz?

leslie

Leslie, I just took ACLS and the Doc and Medic teaching said that the research has shown in to be no more painful than IV access and there, so far, have not been in real increase in infection or clots. I still flinched when we got to drill it into a fake bone though.

[smk1, LPN]

Haven't placed one in real life but am re-certing in ACLS currently and they just showed us a training video in the technique using a hand held drill-type device. In the film they used hospital employees as volunteers; without exception they just sat there through it, smiling and saying how painless it was. One of the volunteers even said that getting a regular IV was more painful. (Those of us watching the film, however were cringing and groaning!):chair:

We saw a film like this as well, and the people didn't even really flinch. Now I would have been sweating and howling and carrying on because it LOOKS painful.

[danissa, LPN, LVN]

Having had IO, while awake, to extract bone marrow, may I say how excrutiatingly painful it is! Local anaesthetic to "Numb" the area..well stick a band aid on an amputation type thing!!! The negative pressure caused by going into the bone was the absolute WORST pain I have felt in my life! I felt like my leg had been severed with a blunt saw! Felt pain for days afterwards.

Only once ever saw it being used in emergency neonatal resus. AND I thought I was going to throw up...brought back some horrible pain memories!

Oh and pain...I'm generally ok in the pain threshold league. have had 3 Nine pound babies, tattoos, piercings...Nothing...and I mean NOTHING..compares to the pain of the IO aspiration!

[smk1, LPN]

Thanks for the real world perspective. What I was told during ACLS is the exact opposite, but I knew just looking at the drill that I would probably have a FAR different reponse than the shiny happy people on the video lol!