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.

[Kidrn911]

From using IO, what do you think about it? I would like to see IO access be used at my hospital during code situations when we are unable to get IV access. I am just curious what everyone that uses IO thinks about it, whether it is beneficial or not.

I have seen good outcome, as it is an acceptable way to gain access. However, often we have to resort to IO, the patient was a goner anyway.

[granite109]

We utilize I/Os in the air as a last resort. HOWEVER, a last resort on a critical kid is 3 attempts at an IV, no longer than 90 seconds total (good luck!) We are also allowed to use them on adults. We recently had a nine y/o brought in to the trauma bay. In this case, the I/O saved her, at least initially. They can be aspirated and the marrow can be used for CBC and Chem. We also infuse 0.5 mg/kg of 2% lido for peds prior to NSS flush, or 40 mg of 2% lido for adults. We use the tibia for peds, and the humerus or tibia for adults. We have the gun and the manual I/Os. They are relatviely simple to use, but yes, very creepy. More and more, they are being advocated. We have a 24 hour limit, but only if no other access if available. Being a trauma center, we can put a CVC in under fluoroscopy 24/7, so I would think that 24 hours would be a liability.

My experience concurs with all the posts: they usually need a pump, they dislodge easily, they are prone to infection. However, they are a lifesaving measure and I have seen them put to good use.

Also, to answer to ETT question. ETT drug administration has been around for years, promoted primarily by AHA via ACLS and PALS as a first round prior to line insertion. The old pnemonic for ETT allowable meds is NAVEL-narcan, atropine, valium, epi and lido. It then changed to OLEAN for oxygen, lido, epi, atropine, and narcan. The doses of epi, lido and atropine are double, but narcan is not. (No atropine in peds at this time.) Recently in PA, they did away with ETT drug admin, finding it to be largely ineffective. They are promoting early I/O use when appropriate. Also, meds cannot be given via a combitube airway.

Hope this clarifies any questions, sorry so long-DFW

[Christie RN2006]

Thank you to everyone!! I assisted with a bone marrow biopsy the other day... all I can say is OUCH!!! When the doc started extracting the marrow this patient started crying even with all the meds we gave!! I can't imagine IO being "painless" especially after seeing a bone marrow biopsy done!

[danissa, LPN, LVN]

Christie, i managed NOT to cry, but focused on holding my hubbys poor hand SO tightly, nearly crushed it! As I said, its the most pain I have encountered EVER!

[leslie :-D]

Christie, i managed NOT to cry, but focused on holding my hubbys poor hand SO tightly, nearly crushed it! As I said, its the most pain I have encountered EVER!

never had it done but no one will ever convince me that it's a painless procedure.

as tazzi said, there's a reason it's recommended for pt to be unconscious.

leslie

[danissa, LPN, LVN]

Leslie, in hindsight..wish I had been knocked out for the whole procedure. think they weighed risk/benefit of GA and thought..just go for it. i really feel for patients who need this, you are right to be convinced that its not painless.