Intraosseous Access - Have You Used It?

LaughingRN · Nov 25, 2012

How often? Honestly almost never

For pediatrics in crisis...yes

For adults in crisis...IV, then EJ, then femoral line

I also have my ACLS and I think the IO is underrated and under utilized....

(Level 1 trauma center)

akulahawkRN, ADN, RN, EMT-P · Nov 25, 2012

I have taken ACLS in the past, I have also been specifically educated on how to do IO access. At the time, IO access was geared primarily towards the pediatric patient. It was up-and-coming in the adult population. I agree that it is probably underutilized and underrated for what it can do an emergency.

If all the equipment is readily available, I would probably do it in this order: peripheral line, EJ, then I would do IO. After that, then I would do anything related to the central venous access, like a femoral or subclavian line whether it be formal central line or using a standard intravenous catheter.

In the few years that I have been doing them, I have done probably a couple thousand peripheral lines, a couple of EJ IV lines, and no interosseous lines. I figure that starting in a few months, I will get back to doing them, and that would include interosseous lines. It has been a long time since I have done an IV line, so I expect that I will be fairly rusty at it when I start up again.

usalsfyre · Nov 25, 2012

I've done a fair number of IOs, to the point I can probably perform an IO faster than a peripheral line. Agree completely with Akulahawk's order of access preference. There's not a good reason to do a "crash" femoral when one of the adult IO devices is available, there's much higher possibility of complications from the central line and a dirty line will have to be changed out later anyway.

Usually it comes down to comfort levels. Most nurses and some physicians seem to be fairly uncomfortable with IO devices, likely because like of exposure.

LearningByMistakes · Nov 25, 2012

I also have placed many IO's, these days it is made much easier using the EZ-IO. I should

state that I am a Paramedic, and not a Nurse. I know that at the Hospitals that I work for,

only Physicans & Paramedics can place IO's, however that is looking to be changed in the

near future.

nuangel1, BSN, RN · Nov 25, 2012

my ed does not use them for the most part .its peripheral iv ,ej or a central line placed by the MD.rarely the md in a code situation if no other access can be obtained will place an easy IO .ocassionally we will get an incoming code with an IO already in place.but we still try to place central access.

psu_213, BSN, RN · Nov 25, 2012

Our ER uses them with some regularity on arrests (all nurses in our ER are trained in how to put them in). The time difference between inserting an IO versus inserting a central line is fairly significant. The bigger issue is that IO access in the tibia requires no stop in compressions. For the most part, inserting a central line does require such an interruption.

My vote: IO during the arrest. Doc inserts a central line after ROSC.

emerjensee · Nov 25, 2012

Thank you for all the wonderful replies... If (hopefully when) I am in the ER setting I will definitely utilize my resources to get some training in this if the facility uses it often enough..

Seems like the frequency of use varies, but I think psu_213 nailed it in that during an arrest that would be the most convienent and indicated route to access since its completely out of the way when using the tibia...

NurseOnAMotorcycle, ASN, RN · Nov 25, 2012

IO is easy. It's just a drill like you use at home. Takes seconds to put it in and you can even use it with pressure bags. Usually used on unresponsive patients for fast access but also because getting it in hurts! Only needed to do it once on a patient who was responsive. He was not a happy camper. :)

PMFB-RN, RN · Nov 26, 2012

I am a full time rapid response nurse. In my roll I place 2-5 IOs a month, usually in codes but not always. I don't need an order and can place at my descretion. There have been a few time when I have placed them in non-code but emergent situations. For me it's PIV 1st and if unavilable / can't get rapidly we go strait to the IO. BTW it is now called EZIO cause back in the day before the drill it wasn't easy:)

Recently my boss has asked me to set up a class to teach the interns how to place and care for IOs. The interns love it and are fun to teach.

BTW I have had a number of patients tell me the IO hurt LESS than an IV in the back of their hand. YMMV. It's usually the infusion, especialy if infusing with a rapid infuser, that hurt the most. Our protocal calls for 20ml of 2% lidocane to be infused first if called for in our judgement. If they are awake I alwasy infuse the lido.

That Guy, BSN, RN, EMT-B · Nov 26, 2012

DRILL BABY DRILL!!! Love em. However they are a short term solution. Use in emergency then obtain other access.

RT_Skyler · Nov 26, 2012

IO is seen mostly in Pediatric patients that are very critical in my area. I have only seen 1 used in an adult, and that was started by EMS.